Healthcare Provider Details

I. General information

NPI: 1902381270
Provider Name (Legal Business Name): TAMARA NICOLE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 PINE ST STE 200
ABILENE TX
79601-2450
US

IV. Provider business mailing address

1904 PINE ST STE 200
ABILENE TX
79601-2450
US

V. Phone/Fax

Practice location:
  • Phone: 325-670-5570
  • Fax: 325-670-5537
Mailing address:
  • Phone: 325-670-5570
  • Fax: 325-670-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138933
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: