Provider Demographics
NPI:1235508920
Name:JONES, MICHELLE MARTINEZ (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARTINEZ
Last Name:JONES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14804
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4043
Mailing Address - Country:US
Mailing Address - Phone:912-384-1477
Mailing Address - Fax:
Practice Address - Street 1:200 DOCTORS DR STE S
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2203
Practice Address - Country:US
Practice Address - Phone:912-292-0658
Practice Address - Fax:912-292-0658
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN115735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F0915238OtherCERTIFICATION
GARN115735OtherNP LICENSE