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General NPI Number Information
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NPI Number | 1962032193
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Entity Type | Individual
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Provider Name | JESSICA MARTINEZ-POMPA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/15/2020
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 1368 OLD MACE ROAD
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City | PATRICK SFB
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State | FL
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Zip | 32953
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Country | US
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Telephone | 321-494-0235
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Fax |
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Provider Business Mailing Address
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Address Line | 14156 E OXEN LN
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City | VAIL
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State | AZ
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Zip | 85641-3503
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 236303
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License Number State | AZ
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