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NPI Code Detail

MEDICARE: DR. TIFFANY MARTINEZ DNP, PMHNP-BC

MEDICARE: DR. TIFFANY MARTINEZ DNP, PMHNP-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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner209034373IL

General Provider Information

NPI Number : 1861341919
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIFFANY MARTINEZ DNP, PMHNP-BC
Provider Business Mailing Address
First Line : 5734 HARVEY AVE
Second Line :
City : LA GRANGE HIGHLANDS
State : IL
Zip : 60525-7008
Country : US
Telephone Number : 630-359-7788
Fax Number :
Provider Business Practice Location Address
First Line : 6201 ROOSEVELT RD
Second Line :
City : BERWYN
State : IL
Zip : 60402-1108
Country : US
Telephone Number : 708-386-0845
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2026
Last Update Date : 01/22/2026

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