Healthcare Provider Details

I. General information

NPI: 1548626229
Provider Name (Legal Business Name): TINA RENEE DUNCAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11335 FONTHILL DR
INDIANAPOLIS IN
46236-8627
US

IV. Provider business mailing address

11335 FONTHILL DR
INDIANAPOLIS IN
46236-8627
US

V. Phone/Fax

Practice location:
  • Phone: 260-416-2930
  • Fax:
Mailing address:
  • Phone: 260-416-2930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG1215114
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG1215114
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71006026A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: