Healthcare Provider Details

I. General information

NPI: 1124248992
Provider Name (Legal Business Name): EMANUEL MARTINEZ, MD AND ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 KINGSLEY AVE SUITE 101
ORANGE PARK FL
32073-4560
US

IV. Provider business mailing address

315 W TOWN PL SUITE 3
ST AUGUSTINE FL
32092-3104
US

V. Phone/Fax

Practice location:
  • Phone: 904-278-4999
  • Fax: 904-278-8891
Mailing address:
  • Phone: 904-940-2200
  • Fax: 904-940-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8366
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW953
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9181473
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9181473
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9222756
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberARNP9208000
License Number StateFL
# 7
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME68758
License Number StateFL

VIII. Authorized Official

Name: DR. EMANUEL MARTINEZ
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 904-940-2200