Provider Demographics
NPI:1710744529
Name:MARTINEZ WATSON, CARIDAD VIVIANA (APRN)
Entity type:Individual
Prefix:
First Name:CARIDAD
Middle Name:VIVIANA
Last Name:MARTINEZ WATSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4662
Mailing Address - Country:US
Mailing Address - Phone:275-537-2737
Mailing Address - Fax:727-553-7275
Practice Address - Street 1:625 6TH AVE S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4662
Practice Address - Country:US
Practice Address - Phone:275-537-2737
Practice Address - Fax:727-553-7275
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11031556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL124181600Medicaid