Provider Demographics
NPI:1942924360
Name:MARTINEZ, DESIREE LYNELL (FNP)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:LYNELL
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6835 82ND ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5078
Mailing Address - Country:US
Mailing Address - Phone:806-535-2909
Mailing Address - Fax:
Practice Address - Street 1:6835 82ND ST STE 101
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5078
Practice Address - Country:US
Practice Address - Phone:806-589-8923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1053062363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily