Healthcare Provider Details

I. General information

NPI: 1598275885
Provider Name (Legal Business Name): EZEQUIEL EMILIANO MARTINEZ ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 LAKESIDE VILLAGE LN
WINDERMERE FL
34786-7024
US

IV. Provider business mailing address

1313 RED PONY RANCH RD
DELAND FL
32724-7987
US

V. Phone/Fax

Practice location:
  • Phone: 407-876-2273
  • Fax:
Mailing address:
  • Phone: 407-617-8348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9386890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: