Provider Demographics
NPI:1629655824
Name:MARTIN, CHRISTIE (CNA)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 DUVAL STATION RD UNIT 127
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-1970
Mailing Address - Country:US
Mailing Address - Phone:904-699-3124
Mailing Address - Fax:
Practice Address - Street 1:225 DUVAL STATION RD UNIT 127
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-1970
Practice Address - Country:US
Practice Address - Phone:904-699-3124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide