Provider Demographics
NPI:1053132183
Name:MARTINEZ, LACY E (APRN)
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SUNFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1768
Mailing Address - Country:US
Mailing Address - Phone:817-296-7769
Mailing Address - Fax:
Practice Address - Street 1:8700 US HIGHWAY 380 STE 300
Practice Address - Street 2:
Practice Address - City:CROSS ROADS
Practice Address - State:TX
Practice Address - Zip Code:76227-2661
Practice Address - Country:US
Practice Address - Phone:940-365-7033
Practice Address - Fax:940-365-7048
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1178459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily