Healthcare Provider Details

I. General information

NPI: 1710772280
Provider Name (Legal Business Name): MARISEL DEL CARMEN TRISTA MARTINEZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 NW 36TH ST
MIAMI FL
33142-5357
US

IV. Provider business mailing address

655 NW 123RD PATH
MIAMI FL
33182-2050
US

V. Phone/Fax

Practice location:
  • Phone: 786-502-3857
  • Fax: 786-391-3787
Mailing address:
  • Phone: 561-667-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF-02250662
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: