Healthcare Provider Details

I. General information

NPI: 1063256774
Provider Name (Legal Business Name): BRIAN EDWARD MARTINEZ DNP, APRN, AGCNS-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

3161 FLORAL WAY E
APOPKA FL
32703-6616
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-9568
  • Fax:
Mailing address:
  • Phone: 540-810-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License NumberAPRN9438879
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: