Healthcare Provider Details

I. General information

NPI: 1033049549
Provider Name (Legal Business Name): LISSETT MARTINEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 SW 106TH AVE
MIAMI FL
33165-3629
US

IV. Provider business mailing address

3730 SW 106TH AVE
MIAMI FL
33165-3629
US

V. Phone/Fax

Practice location:
  • Phone: 305-927-9040
  • Fax:
Mailing address:
  • Phone: 305-927-9040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025098015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: