Provider Demographics
NPI:1013109354
Name:MARTIN, JILL MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 HELDERBERG TRAIL
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:NY
Mailing Address - Zip Code:12023-2927
Mailing Address - Country:US
Mailing Address - Phone:518-872-0009
Mailing Address - Fax:518-874-0961
Practice Address - Street 1:1705 HELDERBERG TRAIL
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:NY
Practice Address - Zip Code:12023-2927
Practice Address - Country:US
Practice Address - Phone:518-872-0009
Practice Address - Fax:518-874-0961
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner