Provider Demographics
NPI:1437127917
Name:MARTIN, GINA (CRNP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-BC
Mailing Address - Street 1:1500 DIXON ST #202
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401
Mailing Address - Country:US
Mailing Address - Phone:540-370-0430
Mailing Address - Fax:540-370-0021
Practice Address - Street 1:1500 DIXON ST #202
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-370-0430
Practice Address - Fax:540-370-0021
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164764363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0087OtherCAREFIRST BC OF NCA NUMBE
VA010064741Medicaid
MD040593900Medicaid
MD64135601OtherCAREFIRST BC OF MD
VA004033G65Medicare ID - Type Unspecified
DC0087OtherCAREFIRST BC OF NCA NUMBE
MD64135601OtherCAREFIRST BC OF MD