Provider Demographics
NPI:1043400351
Name:GOODYEAR, MARTHA (APN, MSN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:GOODYEAR
Suffix:
Gender:F
Credentials:APN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 23RD AVE N STE 401
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1513
Mailing Address - Country:US
Mailing Address - Phone:615-277-2437
Mailing Address - Fax:614-320-0240
Practice Address - Street 1:345 23RD AVE N STE 401
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1513
Practice Address - Country:US
Practice Address - Phone:615-277-2437
Practice Address - Fax:614-320-0240
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12707363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner