Individual
JESSICA M. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
482 S BROAD ST, MERIDEN, CT 06450-6656
(203) 439-4485
Mailing address
4 FARM SPRINGS RD, FARMINGTON, CT 06032-2573
(860) 284-5200
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
004871
CT
363LF0000X
Family Nurse Practitioner
Primary
004871
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4871
CT STATE LIC
CT
Enumeration date
08/04/2009
Last updated
09/06/2019
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