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Individual
TAMMY PRUITT MARTINEZ
Active
Individual
TAMMY PRUITT MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA00359
RI
363A00000X
Physician Assistant
Primary
PA9110936
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619944154
NPI
—
01
—
939025129
RI MEDICARE GROUP NUMBER
—
01
—
PA00359
RI LICENSE
RI
Enumeration date
03/03/2006
Last updated
09/28/2023
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