MEDICARE: BREANNA LEIGH MARTIN FNP-C

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	5011654	NC
2	363LF0000X	Family Nurse Practitioner	22667	SC

General Provider Information

NPI Number	:	1831650316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA LEIGH MARTIN FNP-C

Provider Business Mailing Address
First Line	:	5216 BAY RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-9505
Country	:	US
Telephone Number	:	803-804-3280
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 6TH BAXTER XING
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-6596
Country	:	US
Telephone Number	:	803-835-2088
Fax Number	:

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

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	04/22/2026

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