Provider Demographics
NPI:1427203793
Name:MARTIN, JOY L (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1310 E 7TH ST STE 4
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-2534
Practice Address - Country:US
Practice Address - Phone:260-920-2000
Practice Address - Fax:260-920-3623
Is Sole Proprietor?:No
Enumeration Date:2008-11-29
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-08453363LF0000X
IN71002685A363L00000X
INRN-28087051163W00000X
OHRN-220845163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200953770Medicaid
INP00776421OtherRAILROAD MEDICARE
000000643476OtherANTHEM BCBS
INP00776421OtherRAILROAD MEDICARE