Provider Demographics
NPI:1831900166
Name:MARTINELLI, JEREMY DEAN (RN)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:DEAN
Last Name:MARTINELLI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 DOSS RD # 50
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-1251
Mailing Address - Country:US
Mailing Address - Phone:405-388-8583
Mailing Address - Fax:
Practice Address - Street 1:1710 RED RIVER ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78712-1918
Practice Address - Country:US
Practice Address - Phone:512-417-7913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1123440390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program