Healthcare Provider Details

I. General information

NPI: 1972296218
Provider Name (Legal Business Name): ASHLEY MARTINEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/22/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0527
US

IV. Provider business mailing address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0527
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-1285
  • Fax: 409-772-5611
Mailing address:
  • Phone: 409-772-1285
  • Fax: 409-772-5611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1113007
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: