Provider Demographics
NPI:1912295197
Name:MARTIN, BRICIN ELIZABETH (APN)
Entity Type:Individual
Prefix:
First Name:BRICIN
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2301 SPRINGHILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7568
Mailing Address - Country:US
Mailing Address - Phone:501-847-2500
Mailing Address - Fax:501-943-3016
Practice Address - Street 1:2301 SPRINGHILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-7568
Practice Address - Country:US
Practice Address - Phone:501-847-2500
Practice Address - Fax:501-943-3016
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARA03575363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics