MEDICARE: JENNIFER ELIZABETH TONGE-MARTIN APRN,BC

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	363LF0000X	Family Nurse Practitioner	VP002144B	PA

General Provider Information

NPI Number	:	1649276288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELIZABETH TONGE-MARTIN APRN,BC

Provider Business Mailing Address
First Line	:	2218 CHALCEDONY ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3761
Country	:	US
Telephone Number	:	860-235-3374
Fax Number	:	526-556-9419

Provider Business Practice Location Address
First Line	:	2450 CRAVEN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92136-5599
Country	:	US
Telephone Number	:	858-556-7784
Fax Number	:	858-556-9419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/08/2007

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