Healthcare Provider Details

I. General information

NPI: 1962032193
Provider Name (Legal Business Name): JESSICA MARTINEZ-POMPA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 02/21/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 OLD MACE ROAD
PATRICK SFB FL
32953
US

IV. Provider business mailing address

14156 E OXEN LN
VAIL AZ
85641-3503
US

V. Phone/Fax

Practice location:
  • Phone: 321-494-0235
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number236303
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: