Basic Information
| Provider Information | |||||||||
| NPI: | 1790931962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | LINDA | ||||||||
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| Credential: | FAMILY NURSE PRACTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4730 COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763844009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405529901 | ||||||||
| FaxNumber: | 9405532523 | ||||||||
| Practice Location | |||||||||
| Address1: | 4730 COLLEGE DR | ||||||||
| Address2: | |||||||||
| City: | VERNON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763844009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9405529901 | ||||||||
| FaxNumber: | 9405532523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2008 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F0407011 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | F0407011 | 01 | TX | LICENSURE | OTHER |