Jennifer J Martin, PA
Physician Assistant, Medical in Va Beach, VA. Individual provider (NPI-1).
NPI number1104863943
StatusActive
Last updated in NPPESApr 6, 2020
Details
- NPI
- 1104863943
- Entity type
- Individual (NPI-1)
- Name
- Jennifer J Martin
- Credential
- PA
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 1, 2006
- Certification date
- Apr 6, 2020
- Last updated
- Apr 6, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 0110005030 | VA | Yes |
| 363A00000X | Physician Assistant | 004226 | MI | |
| 363A00000X | Physician Assistant | PA9113129 | FL |
Practice location
4092 Foxwood DrSte 101
Va Beach, VA 23462-5225
Phone 757-686-3508 · Fax 757-686-0541
Mailing address
Po Box 7549Portsmouth, VA 23707-0549
Phone 757-686-3508 · Fax 757-686-0541
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