Healthcare Provider Details

I. General information

NPI: 1023151628
Provider Name (Legal Business Name): THERESA MARTIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 MARYLAND WAY
BRENTWOOD TN
37027-1200
US

IV. Provider business mailing address

5115 MARYLAND WAY
BRENTWOOD TN
37027-1200
US

V. Phone/Fax

Practice location:
  • Phone: 615-628-7176
  • Fax: 615-468-8370
Mailing address:
  • Phone: 615-628-7176
  • Fax: 615-468-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number132505
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13106
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: