Individual
JACOB MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 STATE ST, ERIE, PA 16550-0001
(814) 877-6000
Mailing address
201 STATE ST, ERIE, PA 16550-0001
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
TLRN073765
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TLRN073765
PA RN LICENSE
PA
Enumeration date
11/10/2023
Last updated
11/10/2023
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