MEDICARE: ANDREA SUZANNE MARTIN RN, MSN, 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	363LA2200X	Adult Health Nurse Practitioner	618452	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	618452	OTHER	TX	STATE LICENSE

General Provider Information

NPI Number	:	1841293875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SUZANNE MARTIN RN, MSN, FNP-C

Provider Business Mailing Address
First Line	:	8144 WALNUT HILL LN
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75231-4388
Country	:	US
Telephone Number	:	214-540-0700
Fax Number	:	214-540-0701

Provider Business Practice Location Address
First Line	:	8144 WALNUT HILL LN
Second Line	:	SUITE 800
City	:	DALLAS
State	:	TX
Zip	:	75231-4388
Country	:	US
Telephone Number	:	214-540-0700
Fax Number	:	214-540-0701

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	09/26/2011

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