Provider Demographics
NPI:1720008618
Name:MARTIN, SHARMISA C (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHARMISA
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHARMISA
Other - Middle Name:C
Other - Last Name:BOHAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:850 HARVARD WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2055
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:1500 E 2ND ST STE 400
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1198
Practice Address - Country:US
Practice Address - Phone:775-982-2400
Practice Address - Fax:775-982-3294
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN00414363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
11832763OtherCAQH
NVCC2750OtherBLUE CROSS BLUE SHIELD
NV1720008618Medicaid
NVCC2750OtherBLUE CROSS BLUE SHIELD
NV500023390Medicare PIN