Provider Demographics
NPI:1679673461
Name:COBB, MARTHA JULIA (RN FNP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JULIA
Last Name:COBB
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:JULIA
Other - Last Name:COBB EILERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN FNP
Mailing Address - Street 1:353 JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:KINGSBURY
Mailing Address - State:TX
Mailing Address - Zip Code:78638-2117
Mailing Address - Country:US
Mailing Address - Phone:361-449-0624
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:MAIL ROUTE MN 008-B213
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:361-449-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX70132711OtherDPS
TX642399OtherBNE LICENSE
TXMC1065689OtherDEA