Provider Demographics
NPI:1568237956
Name:MARTINEZ, TIFFANY (FNP-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13559 TIMBERS RD
Mailing Address - Street 2:
Mailing Address - City:CARLETON
Mailing Address - State:MI
Mailing Address - Zip Code:48117-9560
Mailing Address - Country:US
Mailing Address - Phone:734-708-8057
Mailing Address - Fax:
Practice Address - Street 1:13559 TIMBERS RD
Practice Address - Street 2:
Practice Address - City:CARLETON
Practice Address - State:MI
Practice Address - Zip Code:48117-9560
Practice Address - Country:US
Practice Address - Phone:734-708-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF112300005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily