Provider Demographics
NPI:1427339209
Name:MARTIN, JENNIFER ELISE (CPNP-PC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14960 PARK ROW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-5165
Mailing Address - Country:US
Mailing Address - Phone:281-298-1144
Mailing Address - Fax:281-298-1133
Practice Address - Street 1:920 MEDICAL PLAZA DR STE 120
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3275
Practice Address - Country:US
Practice Address - Phone:281-298-1144
Practice Address - Fax:281-298-1133
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP120661363LP0200X
TX754961363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287462011Medicaid