Healthcare Provider Details

I. General information

NPI: 1043211741
Provider Name (Legal Business Name): TINA M WRIGHT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 CURTIS DR SUITE B
WINAMAC IN
46996-8818
US

IV. Provider business mailing address

2418 CURTIS DR SUITE B
WINAMAC IN
46996-8818
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-7900
  • Fax: 574-946-7936
Mailing address:
  • Phone: 574-946-7900
  • Fax: 574-946-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001001A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: