Provider Demographics
NPI:1417625807
Name:MARTIN, TESHA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:TESHA
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 COUNTY SERVICES DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37015-1748
Mailing Address - Country:US
Mailing Address - Phone:615-792-4318
Mailing Address - Fax:
Practice Address - Street 1:162 COUNTY SERVICES DR
Practice Address - Street 2:
Practice Address - City:ASHLAND CITY
Practice Address - State:TN
Practice Address - Zip Code:37015-1748
Practice Address - Country:US
Practice Address - Phone:615-792-4318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000073750164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse