Provider Demographics
NPI:1386985273
Name:MARTIN, PATRICE JACKSON (MSN, RN, ANP-BC, CNP)
Entity type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:JACKSON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSN, RN, ANP-BC, CNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:83 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01436-1215
Mailing Address - Country:US
Mailing Address - Phone:178-168-2586
Mailing Address - Fax:617-544-0267
Practice Address - Street 1:83 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:BALDWINVILLE
Practice Address - State:MA
Practice Address - Zip Code:01436-1215
Practice Address - Country:US
Practice Address - Phone:178-168-2586
Practice Address - Fax:617-544-0267
Is Sole Proprietor?:No
Enumeration Date:2013-03-03
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2271823363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110095829AMedicaid