Provider Demographics
NPI:1477223766
Name:MARTIN, PATRICIA NICOLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:NICOLE
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 1:1600 WILLOW ST STE A
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-4264
Mailing Address - Country:US
Mailing Address - Phone:812-291-5993
Mailing Address - Fax:812-316-1117
Practice Address - Street 1:1600 WILLOW ST STE A
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-4264
Practice Address - Country:US
Practice Address - Phone:812-291-5993
Practice Address - Fax:812-316-1117
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28209478A163W00000X
IN71011590A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse