Provider Demographics
NPI:1164252268
Name:MARTINEZ DIAZ, JORGE DANIEL (FNP-C)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:DANIEL
Last Name:MARTINEZ DIAZ
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6746 NW 188TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2431
Mailing Address - Country:US
Mailing Address - Phone:702-801-1128
Mailing Address - Fax:
Practice Address - Street 1:6746 NW 188TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2431
Practice Address - Country:US
Practice Address - Phone:702-801-1128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11034340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily