Healthcare Provider Details

I. General information

NPI: 1669077673
Provider Name (Legal Business Name): MARIANA MARTINEZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8932 SW 97TH AVE
MIAMI FL
33176-1936
US

IV. Provider business mailing address

8932 SW 97TH AVE
MIAMI FL
33176-1936
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6006
  • Fax: 305-243-3919
Mailing address:
  • Phone: 305-243-6006
  • Fax: 305-243-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11010036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: