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General NPI Number Information
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NPI Number | 1598417701
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Entity Type | Individual
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Provider Name | AMANDA MARIE MARTIN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 4110 W SWEETWATER DR
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City | TUCSON
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State | AZ
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Zip | 85745-9348
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Country | US
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Telephone | 888-480-0530
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Fax |
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Provider Business Mailing Address
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Address Line | 3505 W PLACITA DE LA TIERRA
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City | TUCSON
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State | AZ
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Zip | 85746-2176
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Country | US
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Telephone | 520-954-5373
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 269052
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License Number State | AZ
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