Provider Demographics
NPI:1003638545
Name:MARTIN, TIMOTHY (DNP)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SWEET SPOT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7633
Mailing Address - Country:US
Mailing Address - Phone:702-324-7702
Mailing Address - Fax:
Practice Address - Street 1:245 SWEET SPOT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7633
Practice Address - Country:US
Practice Address - Phone:702-324-7702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV884137363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health