Provider Demographics
NPI:1801293287
Name:MARTIN TOUSSAINT, MARCIA ROSE (NP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ROSE
Last Name:MARTIN TOUSSAINT
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 1:835 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1429
Mailing Address - Country:US
Mailing Address - Phone:917-439-9280
Mailing Address - Fax:516-771-2982
Practice Address - Street 1:835 SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1429
Practice Address - Country:US
Practice Address - Phone:917-439-9280
Practice Address - Fax:516-771-2982
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY508185163W00000X
NY305979363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health