Provider Demographics
NPI:1780163592
Name:MARTIN, JACOB COURTLYN (ARNP)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:COURTLYN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7422
Mailing Address - Country:US
Mailing Address - Phone:352-873-0707
Mailing Address - Fax:352-873-9615
Practice Address - Street 1:3310 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7422
Practice Address - Country:US
Practice Address - Phone:352-873-0707
Practice Address - Fax:352-873-9615
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9408905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty