Healthcare Provider Details

I. General information

NPI: 1912820705
Provider Name (Legal Business Name): JOHNATHAN MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19596 NW 56TH AVE
STARKE FL
32091-5102
US

IV. Provider business mailing address

19596 NW 56TH AVE
STARKE FL
32091-5102
US

V. Phone/Fax

Practice location:
  • Phone: 904-833-2573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: