Provider Demographics
NPI:1740784594
Name:MARTIN, TAMEKA TRENDA (FNP-C, AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TAMEKA
Middle Name:TRENDA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-C, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S BECKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1908
Mailing Address - Country:US
Mailing Address - Phone:903-590-5611
Mailing Address - Fax:903-535-6884
Practice Address - Street 1:910 E HOUSTON ST STE 550
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702
Practice Address - Country:US
Practice Address - Phone:903-606-8718
Practice Address - Fax:903-606-1218
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136241363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8JF321OtherBCBS
TXP02026182OtherMEDICARE RAIL ROAD
TX642399YMAFOtherMEDICARE
TX382699201Medicaid