Provider Demographics
NPI:1942676424
Name:MARTIN, TILDA (APRN)
Entity Type:Individual
Prefix:
First Name:TILDA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1649 LUCERNE ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4369
Mailing Address - Country:US
Mailing Address - Phone:775-782-1603
Mailing Address - Fax:775-782-3417
Practice Address - Street 1:1649 LUCERNE ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4369
Practice Address - Country:US
Practice Address - Phone:775-782-1603
Practice Address - Fax:775-782-3417
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner