Healthcare Provider Details

I. General information

NPI: 1659725430
Provider Name (Legal Business Name): TRACY MICHELLE HILBURN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY MICHELLE MARTIN NP

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S. BLOOMINGTON ST.
GREENCASTLE IN
46135
US

IV. Provider business mailing address

1542 S. BLOOMINGTON ST.
GREENCASTLE IN
46135
US

V. Phone/Fax

Practice location:
  • Phone: 765-301-7030
  • Fax: 765-301-7035
Mailing address:
  • Phone: 765-301-7030
  • Fax: 765-301-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28184763A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71006663A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006674A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: