Healthcare Provider Details

I. General information

NPI: 1164654620
Provider Name (Legal Business Name): YASMANY MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6421 GOLDEN DR
TAMPA FL
33634-4924
US

IV. Provider business mailing address

1803 W SLIGH AVE
TAMPA FL
33604-5811
US

V. Phone/Fax

Practice location:
  • Phone: 813-727-4303
  • Fax:
Mailing address:
  • Phone: 813-935-5709
  • Fax: 813-935-5830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048806
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: