Provider Demographics
NPI:1295214443
Name:MARTIN, JAMIE N (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1264 HAWKS FLIGHT CT STE 100
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9354
Practice Address - Country:US
Practice Address - Phone:916-933-4222
Practice Address - Fax:916-933-5574
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA55947363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant