Provider Demographics
NPI:1043213390
Name:MARTIN, TONI M (NP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-354-1052
Mailing Address - Fax:812-354-8280
Practice Address - Street 1:106 W PIKE AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47567-8750
Practice Address - Country:US
Practice Address - Phone:812-354-1052
Practice Address - Fax:812-354-8280
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000707A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200286470Medicaid
IN000000337169OtherBCBS PIN
IN000000337169OtherBCBS PIN
INQ25594Medicare UPIN
IN200286470Medicaid
INM4000045202Medicare PIN