Provider Demographics
NPI:1861846842
Name:MARTIN, JENNIFER NICOLE (LVN)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8621 FOREST HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7712
Mailing Address - Country:US
Mailing Address - Phone:817-304-1172
Mailing Address - Fax:
Practice Address - Street 1:8621 FOREST HIGHLANDS DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7712
Practice Address - Country:US
Practice Address - Phone:817-304-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218982164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218982OtherTEXAS BOARD OF NURSING