Healthcare Provider Details

I. General information

NPI: 1114467776
Provider Name (Legal Business Name): CONNIE L MARTINEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 CAPITAL BLVD
RALEIGH NC
27604-4478
US

IV. Provider business mailing address

PO BOX 746724
ATLANTA GA
30374-6724
US

V. Phone/Fax

Practice location:
  • Phone: 919-980-7008
  • Fax:
Mailing address:
  • Phone: 919-980-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9180821
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: