Provider Demographics
NPI:1548046857
Name:MARTIN, PRISCILLA (FNP)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
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 1:586 S JEFFERSON AVE STE P
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4632
Mailing Address - Country:US
Mailing Address - Phone:931-854-0050
Mailing Address - Fax:
Practice Address - Street 1:586 S JEFFERSON AVE STE P
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4632
Practice Address - Country:US
Practice Address - Phone:931-854-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN216648163W00000X
TN34613363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse