Healthcare Provider Details

I. General information

NPI: 1699013573
Provider Name (Legal Business Name): CRYSTAL A MARTINEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 DISCOVERY DR
ORLANDO FL
32826-3709
US

IV. Provider business mailing address

17 ARECA DR
ORLANDO FL
32807-5031
US

V. Phone/Fax

Practice location:
  • Phone: 407-427-4118
  • Fax:
Mailing address:
  • Phone: 407-427-4118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN9525425
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number311926
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: