MEDICARE: MRS. JESSICA MARIE MARTIN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.021592	OH

General Provider Information

NPI Number	:	1932618642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA MARIE MARTIN CNP

Provider Business Mailing Address
First Line	:	14445 WATT RD
Second Line	:
City	:	NOVELTY
State	:	OH
Zip	:	44072-9634
Country	:	US
Telephone Number	:	440-488-6364
Fax Number	:

Provider Business Practice Location Address
First Line	:	13221 RAVENNA RD STE 8
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-9016
Country	:	US
Telephone Number	:	440-286-6155
Fax Number	:	440-286-6156

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	06/17/2024

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