Provider Demographics
NPI:1528932365
Name:MARTINEZ, JESSICA ROSE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ROSE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:NM
Mailing Address - Zip Code:87715-0002
Mailing Address - Country:US
Mailing Address - Phone:575-387-2201
Mailing Address - Fax:575-387-9006
Practice Address - Street 1:3 MORA VALLEY CLINIC RD
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:NM
Practice Address - Zip Code:87732-2202
Practice Address - Country:US
Practice Address - Phone:575-387-2201
Practice Address - Fax:575-387-9006
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM54060363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care