Healthcare Provider Details

I. General information

NPI: 1699066910
Provider Name (Legal Business Name): TRENISE ROBINSON MARTINEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRENISE R ROBINSON PA-C

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
NEW ORLEANS LA
70121-2429
US

IV. Provider business mailing address

1130 TALBOTTON RD
COLUMBUS GA
31904-8749
US

V. Phone/Fax

Practice location:
  • Phone: 504-842-4015
  • Fax: 504-842-0098
Mailing address:
  • Phone: 706-641-6900
  • Fax: 706-327-0757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2173
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200616.RX
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: