Provider Demographics
NPI:1841293875
Name:MARTIN, ANDREA SUZANNE (RN, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SUZANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8144 WALNUT HILL LN
Mailing Address - Street 2:SUITE 800
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4388
Mailing Address - Country:US
Mailing Address - Phone:214-540-0700
Mailing Address - Fax:214-540-0701
Practice Address - Street 1:8144 WALNUT HILL LN
Practice Address - Street 2:SUITE 800
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4388
Practice Address - Country:US
Practice Address - Phone:214-540-0700
Practice Address - Fax:214-540-0701
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX618452363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX618452OtherSTATE LICENSE
TX8C1051Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
TX618452OtherSTATE LICENSE
TXQ08278Medicare UPIN