=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043119282
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JHACKELIN MARTINEZ NP, PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2026
-----------------------------------------------------
Last Update Date | 11/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12535 ORANGE DR STE 607
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33330-4307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-452-2919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7003 LOCH ISLE DR S
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-2081
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-452-2919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11021292
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------