Provider Demographics
NPI:1174382154
Name:MARTINEZ, EMALIE ANN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:EMALIE
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 S BARBARA AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-3106
Mailing Address - Country:US
Mailing Address - Phone:928-246-4270
Mailing Address - Fax:
Practice Address - Street 1:950 E MAIN ST BLDG B
Practice Address - Street 2:
Practice Address - City:SOMERTON
Practice Address - State:AZ
Practice Address - Zip Code:85350-7409
Practice Address - Country:US
Practice Address - Phone:928-366-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ304974363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health