Provider Demographics
NPI:1902105406
Name:MARTIN, TAMI MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:MARIE
Last Name:MARTIN
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 1:324 SW 7TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4900
Mailing Address - Country:US
Mailing Address - Phone:541-265-4253
Mailing Address - Fax:541-237-1093
Practice Address - Street 1:324 SW 7TH ST STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4900
Practice Address - Country:US
Practice Address - Phone:541-265-4253
Practice Address - Fax:541-237-1093
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150134NP363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500651733Medicaid