Healthcare Provider Details

I. General information

NPI: 1477223766
Provider Name (Legal Business Name): PATRICIA NICOLE MARTIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N ILLINOIS ST
INDIANAPOLIS IN
46204-1904
US

IV. Provider business mailing address

201 N ILLINOIS ST
INDIANAPOLIS IN
46204-1904
US

V. Phone/Fax

Practice location:
  • Phone: 888-731-8994
  • Fax:
Mailing address:
  • Phone: 888-731-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28209478A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71011590A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: