Healthcare Provider Details

I. General information

NPI: 1023055407
Provider Name (Legal Business Name): ANA G. MARTINEZ FUENTES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE STE 902
MIAMI FL
33133-4236
US

IV. Provider business mailing address

3661 S MIAMI AVE STE 902
MIAMI FL
33133-4236
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-0302
  • Fax: 305-854-0308
Mailing address:
  • Phone: 305-854-0302
  • Fax: 305-854-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9222125
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9222125
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: