Provider Demographics
NPI:1164937736
Name:MARTIN, JULIE ELISABETH (CPNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ELISABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 NORTH COUNTY ROAD 1152
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705
Mailing Address - Country:US
Mailing Address - Phone:972-921-9568
Mailing Address - Fax:
Practice Address - Street 1:5019 PORTICO WAY
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-3102
Practice Address - Country:US
Practice Address - Phone:432-242-0540
Practice Address - Fax:432-242-0541
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135967363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics