MEDICARE: REGINA HIKARI MARTINEZ AGACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	1159155	TX
2	363LA2100X	Acute Care Nurse Practitioner	1159155	TX

General Provider Information

NPI Number	:	1619724267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA HIKARI MARTINEZ AGACNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 7572
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77387-7572
Country	:	US
Telephone Number	:	832-335-8566
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 7572
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77387-7572
Country	:	US
Telephone Number	:	832-335-8566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2024
Last Update Date	:	10/05/2024

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