MEDICARE: CYNTHIA R. MARTIN APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	61883	TN

General Provider Information

NPI Number	:	1649347303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA R. MARTIN APRN

Provider Business Mailing Address
First Line	:	684 OLD ORCHARD RD
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-5194
Country	:	US
Telephone Number	:	615-377-9571
Fax Number	:

Provider Business Practice Location Address
First Line	:	2339 HILLSBORO RD
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37069-6225
Country	:	US
Telephone Number	:	615-791-8719
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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