Provider Demographics
NPI:1114302817
Name:MARTYAK, JENNIFER STARNES (MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:STARNES
Last Name:MARTYAK
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1225
Mailing Address - Fax:
Practice Address - Street 1:108 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1218
Practice Address - Country:US
Practice Address - Phone:336-481-8655
Practice Address - Fax:336-277-9165
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5007841363L00000X
NCF0115007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily