Provider Demographics
NPI:1184183923
Name:MARTIN, EMILY ANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:TRENTACOSTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2204 LAKESHORE DR STE 440
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-8857
Mailing Address - Country:US
Mailing Address - Phone:205-874-7844
Mailing Address - Fax:205-874-7848
Practice Address - Street 1:2204 LAKESHORE DR STE 440
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-8857
Practice Address - Country:US
Practice Address - Phone:205-874-7844
Practice Address - Fax:205-874-7848
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-153618163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse