Jennifer J Martin, PA
Individual provider Active NPI Medical Physician Assistant · VA Beach, VA
NPI 1104863943 · NPPES record last updated Apr 6, 2020
Key facts
- NPI
- 1104863943
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 0110005030 (VA)
- Practice address
- 4092 Foxwood Dr
Ste 101
VA Beach, VA 23462-5225 - Phone
- (757) 686-3508
- Fax
- (757) 686-0541
- NPI assigned
- Jun 1, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA9113129 | FL | MD | Physician Assistant |
| 004226 | MI | MD | Physician Assistant |
| 0110005030 | VA | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tampa General Hospital | Current | Accepting new patients | |
| Bestpractices of North Carolina PC | Past | Accepting new patients | |
| Franklin Regional Emergency Physicians, PLLC | Past | Accepting new patients |
Interoperability endpoints
- jmartin174482@direct.tgh.org
- https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004226 | MI | |
| Physician Assistant | 363A00000X | PA9113129 | FL | |
| Medical Physician Assistant | 363AM0700X | 0110005030 | VA | Yes |
Addresses
Primary practice location
4092 Foxwood Dr
Ste 101
VA Beach, VA 23462-5225
Mailing address
PO Box 7549
Portsmouth, VA 23707-0549
Phone (757) 686-3508
Other providers in VA Beach, VA
- Latanya Littleton
- Carl Lucas
- Chad R Manke
- Christopher John Maples
- Tricia Marshall
- Kimberly Duncan Martinez
- Mawussi Komi
- Karen McCleu-Jackson
- Natalie McCorey
- Jacob McCrowell
All providers in VA Beach, VA · Medical Physician Assistant in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.