Provider Demographics
NPI:1669911541
Name:MARTIN, MARYANN (APRN)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:ANN
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C, ENP-C
Mailing Address - Street 1:319 MAGNOLIA ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-4639
Mailing Address - Country:US
Mailing Address - Phone:281-910-8399
Mailing Address - Fax:
Practice Address - Street 1:901 HARBORSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550
Practice Address - Country:US
Practice Address - Phone:409-772-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133255207PE0004X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services