Provider Demographics
NPI:1912449059
Name:MARTINEZ, NICOLE KATHLEEN (FNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATHLEEN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:KATHLEEN
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4141 STATE ST STE B6
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1851
Mailing Address - Country:US
Mailing Address - Phone:805-681-7144
Mailing Address - Fax:805-683-6108
Practice Address - Street 1:4141 STATE ST STE B6
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1851
Practice Address - Country:US
Practice Address - Phone:805-681-7144
Practice Address - Fax:805-683-6108
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005374363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner