Provider Demographics
NPI:1972306140
Name:MARTIN, AUTUMN SHEA (FNP-BC)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:SHEA
Last Name:MARTIN
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:567 OAKVALE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-0615
Mailing Address - Country:US
Mailing Address - Phone:615-517-9687
Mailing Address - Fax:
Practice Address - Street 1:1747 MEDICAL CENTER PKWY STE 330
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2597
Practice Address - Country:US
Practice Address - Phone:615-603-8957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN214563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine