Provider Demographics
NPI:1821795055
Name:MARTINEZ, PATRICIA (RN, MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15449 GOODSON RD
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-8406
Mailing Address - Country:US
Mailing Address - Phone:208-447-0526
Mailing Address - Fax:
Practice Address - Street 1:4604 N PENNGROVE WAY # 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-7442
Practice Address - Country:US
Practice Address - Phone:208-992-3324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID53550163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse