Provider Demographics
NPI:1760273718
Name:MARTINEZ, MIA FELICE (NP)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:FELICE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:FELICE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:138 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-1316
Mailing Address - Country:US
Mailing Address - Phone:484-347-9677
Mailing Address - Fax:
Practice Address - Street 1:138 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-1316
Practice Address - Country:US
Practice Address - Phone:484-347-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP032915363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily