Provider Demographics
NPI:1699066910
Name:MARTINEZ, TRENISE ROBINSON (PA-C)
Entity type:Individual
Prefix:
First Name:TRENISE
Middle Name:ROBINSON
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TRENISE
Other - Middle Name:R
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1130 TALBOTTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8749
Mailing Address - Country:US
Mailing Address - Phone:706-641-6900
Mailing Address - Fax:706-327-0757
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-4015
Practice Address - Fax:504-842-0098
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2173363A00000X
LAPA.200616.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2341405Medicaid
MS02354059Medicaid
MS02354059Medicaid