Provider Demographics
NPI:1952690588
Name:MARTIN, AMANDA SUZANNE (APN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:SUZANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:SUZANNE
Other - Last Name:NOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:951 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-4323
Mailing Address - Country:US
Mailing Address - Phone:865-658-5454
Mailing Address - Fax:423-259-8662
Practice Address - Street 1:951 N BROAD ST
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-4323
Practice Address - Country:US
Practice Address - Phone:865-658-5454
Practice Address - Fax:423-259-8662
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily