Provider Demographics
NPI:1720322209
Name:ENNIS-MARTINEZ, ANNA M (NP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:ENNIS-MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 FOX DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-8613
Mailing Address - Country:US
Mailing Address - Phone:405-462-6245
Mailing Address - Fax:540-546-2624
Practice Address - Street 1:33820 OLD VALLEY PIKE STE 2
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:VA
Practice Address - Zip Code:22657
Practice Address - Country:US
Practice Address - Phone:540-459-1310
Practice Address - Fax:540-459-1311
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024170494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1720322209Medicaid