Healthcare Provider Details

I. General information

NPI: 1306489349
Provider Name (Legal Business Name): LUIS MARTIJA MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 SW 136TH PL
MIAMI FL
33175-1047
US

IV. Provider business mailing address

274 NW 133RD CT
MIAMI FL
33182-1617
US

V. Phone/Fax

Practice location:
  • Phone: 786-449-5523
  • Fax:
Mailing address:
  • Phone: 786-449-5523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004568
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11004568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: