1255758389 NPI number — JULIE CALDWELL MARTINEZ PMHNP

Table of content: JULIE CALDWELL MARTINEZ PMHNP (NPI 1255758389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255758389 NPI number — JULIE CALDWELL MARTINEZ PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
JULIE
Provider Middle Name:
CALDWELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255758389
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
27524 CASHFORD CIR STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLEY CHAPEL
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33544-6947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-515-0383
Provider Business Mailing Address Fax Number:
813-906-7789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 E UNION AVE STE 1100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80237-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-414-1164
Provider Business Practice Location Address Fax Number:
813-906-7789
Provider Enumeration Date:
03/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN9287881 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: APRN9287881 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: C-APN.0003518-C-CNS , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y0NJ1 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 013387400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: APRN9287881 . This is a "FL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 013387400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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