Provider Demographics
NPI:1053104398
Name:MARTIN, TESSICA GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:TESSICA
Middle Name:GRACE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2709 WALKERS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-7857
Mailing Address - Country:US
Mailing Address - Phone:336-469-5438
Mailing Address - Fax:
Practice Address - Street 1:653 BLUEFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9626
Practice Address - Country:US
Practice Address - Phone:704-360-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant