Individual provider Active NPI

Ivan Martinez, RN

  • Emergency Registered Nurse
  • Tampa, FL
National Provider Identifier
1780208629
Registry record updated Jun 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Registered NurseTaxonomy code 163WE0003X
License
9381202 Issued in FL
Practice address
2108 N Ola Ave Unit 718
Tampa, FL 33602-2026
Phone
(813) 404-8922
NPI assigned
Jun 6, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Registered Nurse 163WE0003X 9381202 FL Primary

Addresses

Primary practice location

2108 N Ola Ave Unit 718
Tampa, FL 33602-2026

Mailing address

2108 N Ola Ave Unit 718
Tampa, FL 33602-2026
Phone (813) 404-8922

Other identifiers 1

IdentifierTypeStateIssuer
9381202OtherFLSTATE NURSING LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Cerner Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
9381202FLMDEmergency Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591401600000",
    "number": "1780208629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2108 N OLA AVE UNIT 718",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336022026",
            "telephone_number": "813-404-8922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2108 N OLA AVE UNIT 718",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336022026",
            "telephone_number": "813-404-8922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "IVAN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-06",
        "last_updated": "2020-06-06",
        "certification_date": "2020-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "FL",
            "license": "9381202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE NURSING LICENSE",
            "identifier": "9381202",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Cerner",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "7050 Gall Blvd",
            "city": "Zephyrhills",
            "state": "FL",
            "country_code": "US",
            "postal_code": "335411347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.