Healthcare Provider Details

I. General information

NPI: 1477135861
Provider Name (Legal Business Name): JENNIFER MARTINO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2021
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10288 TALL OAKS CIR
PARKER CO
80134-7731
US

IV. Provider business mailing address

10288 TALL OAKS CIR
PARKER CO
80134-7731
US

V. Phone/Fax

Practice location:
  • Phone: 713-213-7572
  • Fax:
Mailing address:
  • Phone: 713-213-7572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberNA0060034250
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1697803
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: