Provider Demographics
NPI:1861701948
Name:MARTIN, ELIZABETH LYNETTE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:LYNETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 765
Mailing Address - Street 2:
Mailing Address - City:KROTZ SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70750-0765
Mailing Address - Country:US
Mailing Address - Phone:337-566-2762
Mailing Address - Fax:337-566-2766
Practice Address - Street 1:216 PARK STREET
Practice Address - Street 2:
Practice Address - City:KROTZ SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70750
Practice Address - Country:US
Practice Address - Phone:337-566-2762
Practice Address - Fax:337-566-2766
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN078570-AP06088363LA2200X
LAAP06088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health