Provider Demographics
NPI:1457782781
Name:MARTINEZ, MISTI A (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MISTI
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 GLEN OAK BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-826-0710
Mailing Address - Fax:615-826-0910
Practice Address - Street 1:107 GLEN OAK BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-826-0710
Practice Address - Fax:615-826-0910
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18071363LA2200X
TNAPN0000018071363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health