Provider Demographics
NPI:1417609249
Name:MARTIN, SANDRA MARYA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MARYA
Last Name:MARTIN
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 1:44546 S AIRPORT RD STE F
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-0341
Mailing Address - Country:US
Mailing Address - Phone:985-500-3500
Mailing Address - Fax:
Practice Address - Street 1:44546 S AIRPORT RD STE F
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-0341
Practice Address - Country:US
Practice Address - Phone:985-500-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-23
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA223693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily