Provider Demographics
NPI:1598205338
Name:MARTIN, TARYN (APRN, FNP-C, ATC,LAT)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN, FNP-C, ATC,LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 8TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-3242
Mailing Address - Country:US
Mailing Address - Phone:605-725-4772
Mailing Address - Fax:
Practice Address - Street 1:2120 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-3242
Practice Address - Country:US
Practice Address - Phone:605-725-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD03652255A2300X
ND430-112255A2300X
NDR48736363LF0000X
SDCP002240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer