Provider Demographics
NPI:1376977488
Name:MARTINEZ, TAMMI JO (FNP-BC, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:JO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-3239
Mailing Address - Country:US
Mailing Address - Phone:573-475-8022
Mailing Address - Fax:573-695-2750
Practice Address - Street 1:46 E STATE HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:PORTAGEVILLE
Practice Address - State:MO
Practice Address - Zip Code:63873-9177
Practice Address - Country:US
Practice Address - Phone:573-391-8031
Practice Address - Fax:573-391-8050
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021019156363LP0808X
MO2013021889363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health