Provider Demographics
NPI:1063813962
Name:MARTINEZ, TIFFANY M (PMHNP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BACK RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT POINT
Mailing Address - State:ME
Mailing Address - Zip Code:04667-4119
Mailing Address - Country:US
Mailing Address - Phone:207-853-0644
Mailing Address - Fax:336-864-2830
Practice Address - Street 1:11 BACK RD
Practice Address - Street 2:
Practice Address - City:PLEASANT POINT
Practice Address - State:ME
Practice Address - Zip Code:04667-4119
Practice Address - Country:US
Practice Address - Phone:207-853-0644
Practice Address - Fax:336-864-2830
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP141057364SC1501X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SC1501XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCommunity Health/Public Health