Provider Demographics
NPI:1831650316
Name:MARTIN, BREANNA LEIGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:LEIGH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 BAY RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9505
Mailing Address - Country:US
Mailing Address - Phone:803-804-3280
Mailing Address - Fax:
Practice Address - Street 1:502 6TH BAXTER XING
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-6596
Practice Address - Country:US
Practice Address - Phone:803-835-2088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011654207Q00000X
SC22667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine