Healthcare Provider Details

I. General information

NPI: 1033631163
Provider Name (Legal Business Name): JAMIE MARIE MARTINKOVIC CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2830 VICTORY PARKWAY ML 806
CINCINNATI OH
45263-1723
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-4831
  • Fax: 513-558-4858
Mailing address:
  • Phone: 513-245-3104
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARPN.CNP.020607
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020607
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: