Provider Demographics
NPI:1578826111
Name:FLUTY, TRACY (FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:FLUTY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308D MEMORIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:TN
Mailing Address - Zip Code:37172-3929
Mailing Address - Country:US
Mailing Address - Phone:615-382-8144
Mailing Address - Fax:615-382-8145
Practice Address - Street 1:2308D MEMORIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:TN
Practice Address - Zip Code:37172-3929
Practice Address - Country:US
Practice Address - Phone:615-382-8144
Practice Address - Fax:615-382-8145
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000016581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily