Provider Demographics
NPI:1043211741
Name:WRIGHT, TINA M (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2418 CURTIS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-8818
Mailing Address - Country:US
Mailing Address - Phone:574-946-7900
Mailing Address - Fax:574-946-7936
Practice Address - Street 1:2418 CURTIS DR
Practice Address - Street 2:SUITE B
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-8818
Practice Address - Country:US
Practice Address - Phone:574-946-7900
Practice Address - Fax:574-946-7936
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71001001A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200355410AMedicaid
IN000001041077OtherANTHEM BLUE CROSS AND BLUE SHIELD
IN670540002Medicare UPIN