MEDICARE: MARIN TELEHEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1023741188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIN TELEHEALTH

Provider Business Mailing Address
First Line	:	1245 COUNTRY CLUB RD STE 200
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9743
Country	:	US
Telephone Number	:	575-332-4633
Fax Number	:	877-209-8941

Provider Business Practice Location Address
First Line	:	1245 COUNTRY CLUB RD STE 200
Second Line	:
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9743
Country	:	US
Telephone Number	:	575-332-4633
Fax Number	:	877-209-8941

Authorized Official
Title or Position	:	OWNER
Name	:	TANYA MARIN
Credential	:	DNP, APRN, CPNP-PC
Telephone Number	:	915-740-4344

Provider Enumeration Date	:	07/06/2022
Last Update Date	:	08/12/2024

Similar Medicare Providers

1699799684 — DR. TANYA VERONICA MARIN DNP, APRN, CPNP-PC/A
Practice Location Address:

1245 COUNTRY CLUB RD , SUITE 200
SANTA TERESA, NM
88008-9743

Practice Phone: 575-332-4633
Practice Fax: 575-332-4635

1366850216 — DR. ANILA EJJIGANI MD
Practice Location Address:

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1316339948 — SANDRA L SHUYA PC
Practice Location Address:

1245 COUNTRY CLUB RD , STE. 200
SANTA TERESA, NM
88008-9743

Practice Phone: 915-235-7676
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1720469679 — TANYA V MARIN, PC
Practice Location Address:

1245 COUNTRY CLUB RD , SUITE 200
SANTA TERESA, NM
88008-9743

Practice Phone: 575-332-4633
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1700240991 — DENOVO CLINICAL SPECIALISTS, P.C.
Practice Location Address:

1245 COUNTRY CLUB RD STE 200
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1588018832 — MAYEDEL SAN JOSE DNP, APRN, FNP-C
Practice Location Address:

1245 COUNTRY CLUB RD STE 200
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88008-9743

Practice Phone: 575-332-4633
Practice Fax:

Directions to “MARIN TELEHEALTH ” Practice Location

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