Provider Demographics
NPI:1649993684
Name:MARTIN, SPENCER FRANCES (CRNP)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:FRANCES
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:SPENCER
Other - Middle Name:FRANCES
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:105 MARION QUIMBY DR
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2529
Mailing Address - Country:US
Mailing Address - Phone:443-838-7200
Mailing Address - Fax:
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3773
Practice Address - Country:US
Practice Address - Phone:410-507-8279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR220752208M00000X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology