Provider Demographics
NPI:1952761017
Name:MARTIN, ANDREA (CRNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6171 EXECUTIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3901
Mailing Address - Country:US
Mailing Address - Phone:202-888-6731
Mailing Address - Fax:202-851-5739
Practice Address - Street 1:6171 EXECUTIVE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3901
Practice Address - Country:US
Practice Address - Phone:202-888-6731
Practice Address - Fax:202-851-5739
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016128363L00000X
MDR253215363L00000X
NJ26NJ00564400363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103243391 0001Medicaid
PA103243391 0001Medicaid