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General NPI Number Information
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NPI Number | 1982180139
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Entity Type | Individual
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Provider Name | COURTNEY ANN MARTINEZ FNP
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Gender | Female
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Dates
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Enumeration Date | 07/11/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 434 SW WILSHIRE BLVD
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City | BURLESON
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State | TX
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Zip | 76028
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Country | US
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Telephone | 817-447-1208
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 961205
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City | FORT WORTH
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State | TX
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Zip | 76161-1205
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Country | US
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Telephone | 817-740-8450
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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 | AP137986
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP137986
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License Number State | TX
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