Provider Demographics
NPI:1962913830
Name:MARTINEZ, YVETTE MARIE (ARNP)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7585 KITTY HAWK STE 201
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-2820
Mailing Address - Country:US
Mailing Address - Phone:210-468-2333
Mailing Address - Fax:210-667-4044
Practice Address - Street 1:7585 KITTY HAWK STE 201
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109
Practice Address - Country:US
Practice Address - Phone:210-468-2333
Practice Address - Fax:210-667-4044
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9360091363L00000X
TXAP137562363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385163601Medicaid