Provider Demographics
NPI:1720410749
Name:RATLIFF, MARTINA STACEY (NP)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:STACEY
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2415 PENNY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8123
Mailing Address - Country:US
Mailing Address - Phone:336-803-4111
Mailing Address - Fax:336-803-4014
Practice Address - Street 1:2415 PENNY RD STE 104
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8123
Practice Address - Country:US
Practice Address - Phone:336-803-4111
Practice Address - Fax:336-803-4014
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5006320363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner