Healthcare Provider Details

I. General information

NPI: 1396110045
Provider Name (Legal Business Name): JENNIFER MAE MARTIN AGACNP-BC/FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 BARNES RD
COLORADO SPRINGS CO
80922-2602
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-522-1133
  • Fax: 719-570-0601
Mailing address:
  • Phone: 719-278-3627
  • Fax: 719-623-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0992147-NP
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992147-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: