Provider Demographics
NPI:1649840885
Name:MARTIN, ELIZABETH M
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N CAVALIER DR
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-6468
Mailing Address - Country:US
Mailing Address - Phone:731-696-4500
Mailing Address - Fax:731-696-2152
Practice Address - Street 1:18 N CAVALIER DR
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-6468
Practice Address - Country:US
Practice Address - Phone:731-696-4500
Practice Address - Fax:731-696-2152
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000029266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily