Provider Demographics
NPI:1427779008
Name:MARTIN, ADAM TYLER (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:TYLER
Last Name:MARTIN
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4670 S HURON ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-5638
Mailing Address - Country:US
Mailing Address - Phone:689-213-7450
Mailing Address - Fax:
Practice Address - Street 1:1265 S BROADWAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-1503
Practice Address - Country:US
Practice Address - Phone:352-227-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021768207Q00000X
COC-APN.0100385-C-NP363LF0000X
COAPN.0999624-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine