Provider Demographics
NPI:1184335085
Name:MARTENS, JONATHAN ROBERT (ACNP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ROBERT
Last Name:MARTENS
Suffix:
Gender:
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N WILMOT RD STE 340
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2607
Mailing Address - Country:US
Mailing Address - Phone:520-703-8718
Mailing Address - Fax:520-844-3398
Practice Address - Street 1:6303 E TANQUE VERDE RD STE 311
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3857
Practice Address - Country:US
Practice Address - Phone:520-703-8718
Practice Address - Fax:520-844-3398
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ287253363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ139764Medicaid
AZZ298147OtherMEDICARE