Provider Demographics
NPI:1356830574
Name:MARTIN, AMY MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 W QUEEN CREEK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-8134
Mailing Address - Country:US
Mailing Address - Phone:480-814-7115
Mailing Address - Fax:480-787-2505
Practice Address - Street 1:1055 W QUEEN CREEK RD STE 3
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-8134
Practice Address - Country:US
Practice Address - Phone:480-814-7115
Practice Address - Fax:480-787-2505
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN129434163W00000X
AZAP11616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse