Healthcare Provider Details

I. General information

NPI: 1578826111
Provider Name (Legal Business Name): TRACY FLUTY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308D MEMORIAL BLVD
SPRINGFIELD TN
37172-3929
US

IV. Provider business mailing address

2308D MEMORIAL BLVD
SPRINGFIELD TN
37172-3929
US

V. Phone/Fax

Practice location:
  • Phone: 615-382-8144
  • Fax: 615-382-8145
Mailing address:
  • Phone: 615-382-8144
  • Fax: 615-382-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000016581
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: