Provider Demographics
NPI:1639242118
Name:MARTIN, SHARON EVE (FNP,CNS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:EVE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3199 LINKSLAND RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8976
Mailing Address - Country:US
Mailing Address - Phone:843-216-8337
Mailing Address - Fax:
Practice Address - Street 1:216 SCOTT ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4345
Practice Address - Country:US
Practice Address - Phone:843-425-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2777363LF0000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCVAD000Medicare UPIN