Provider Demographics
NPI:1447423108
Name:MARTIN, CAROLYN MARIE (MSN, FNP-C, BC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSN, FNP-C, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5812 FURNEAUX DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4729
Mailing Address - Country:US
Mailing Address - Phone:972-608-2634
Mailing Address - Fax:972-964-5348
Practice Address - Street 1:17101 PRESTON RD STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1374
Practice Address - Country:US
Practice Address - Phone:972-239-4441
Practice Address - Fax:972-239-1597
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX532239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse