Healthcare Provider Details

I. General information

NPI: 1639806177
Provider Name (Legal Business Name): JENNIFER MARTINEZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 RIVER AVE UNIT 3
LAKEWOOD NJ
08701-5288
US

IV. Provider business mailing address

1255 JUNE RD
HUNTINGDON VALLEY PA
19006-8405
US

V. Phone/Fax

Practice location:
  • Phone: 732-486-7373
  • Fax:
Mailing address:
  • Phone: 215-520-5638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP026020
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP026020
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP026020
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: