Provider Demographics
NPI:1053302455
Name:MARTIN, CHRISTA LEA (CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:LEA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:CHRISTA
Other - Middle Name:LEA
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1185 MOUNT AETNA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6832
Mailing Address - Country:US
Mailing Address - Phone:240-513-6300
Mailing Address - Fax:240-513-6303
Practice Address - Street 1:1185 MOUNT AETNA RD STE 102
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6832
Practice Address - Country:US
Practice Address - Phone:240-513-6300
Practice Address - Fax:240-513-6303
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD193525363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN