Provider Demographics
NPI:1598048357
Name:MARTIN, SHARON TUNSTALL (CNA)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:TUNSTALL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:TUNSTALL
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2997 KNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-3169
Mailing Address - Country:US
Mailing Address - Phone:901-859-6252
Mailing Address - Fax:
Practice Address - Street 1:2997 KNIGHT RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-3169
Practice Address - Country:US
Practice Address - Phone:901-859-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN111004435374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN111004435Medicaid