Provider Demographics
NPI:1356723217
Name:MARTINEZ, JENNIFER ANN (CNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:DICKERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2545 COACHLITE DR
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-9599
Mailing Address - Country:US
Mailing Address - Phone:517-795-3040
Mailing Address - Fax:
Practice Address - Street 1:2130 W CENTRAL AVE STE 101
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3819
Practice Address - Country:US
Practice Address - Phone:419-291-3900
Practice Address - Fax:419-479-6055
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704189540363L00000X
OHAPRN.CNP.17531363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner