Provider Demographics
NPI:1124205406
Name:MARTINEZ, MARGO V (FNP)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:V
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARTO
Other - Middle Name:
Other - Last Name:VILLARREAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1515 PAPPAS ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1705
Mailing Address - Country:US
Mailing Address - Phone:956-523-3642
Mailing Address - Fax:956-718-6294
Practice Address - Street 1:1515 PAPPAS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1705
Practice Address - Country:US
Practice Address - Phone:956-523-3642
Practice Address - Fax:956-718-6294
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP116087363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX666861OtherTX BD OF NURSE EXAMINERS
TXF1007089OtherFNP CERTIFICATION PGM