Provider Demographics
NPI:1477223766
Name:MARTIN, PATRICIA NICOLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:NICOLE
Last Name:MARTIN
Suffix:
Gender:F
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 1:13368 E JONES RD
Mailing Address - Street 2:
Mailing Address - City:MONROE CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47557-7412
Mailing Address - Country:US
Mailing Address - Phone:812-887-2092
Mailing Address - Fax:
Practice Address - Street 1:201 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1904
Practice Address - Country:US
Practice Address - Phone:888-731-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28209478A163W00000X
IN71011590A363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse