Provider Demographics
NPI:1194284489
Name:MARTIN, CAITLIN
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 TOWNE CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-1280
Mailing Address - Country:US
Mailing Address - Phone:817-306-5630
Mailing Address - Fax:817-306-5631
Practice Address - Street 1:833 TOWNE CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-1280
Practice Address - Country:US
Practice Address - Phone:817-306-5630
Practice Address - Fax:817-306-5631
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily