Provider Demographics
NPI:1851069702
Name:MARTIN, AMY NAZARIO (CRNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:NAZARIO
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 396
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35962-0396
Mailing Address - Country:US
Mailing Address - Phone:256-925-0012
Mailing Address - Fax:256-925-0016
Practice Address - Street 1:15239 AL HIGHWAY 68 STE B
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35962-3481
Practice Address - Country:US
Practice Address - Phone:256-925-0012
Practice Address - Fax:256-925-0016
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-124897363LF0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse