Healthcare Provider Details

I. General information

NPI: 1558115865
Provider Name (Legal Business Name): LAURA RIVERA MARTIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 04/15/2024
Certification Date: 04/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 PARK BEND DR STE 300
AUSTIN TX
78758-5674
US

IV. Provider business mailing address

3200 COLLEGE PARK DR UNIT 106
ROUND ROCK TX
78665-1626
US

V. Phone/Fax

Practice location:
  • Phone: 512-382-1933
  • Fax:
Mailing address:
  • Phone: 305-316-4717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11030470
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: