Provider Demographics
NPI:1710772280
Name:TRISTA MARTINEZ, MARISEL DEL CARMEN (APRN)
Entity type:Individual
Prefix:
First Name:MARISEL
Middle Name:DEL CARMEN
Last Name:TRISTA MARTINEZ
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 NW 123RD PATH
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2050
Mailing Address - Country:US
Mailing Address - Phone:561-667-8136
Mailing Address - Fax:
Practice Address - Street 1:2215 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5357
Practice Address - Country:US
Practice Address - Phone:786-502-3857
Practice Address - Fax:786-391-3787
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF-02250662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily