Provider Demographics
NPI:1639652498
Name:MOSEMAN, TRACY M (FNP)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:M
Last Name:MOSEMAN
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 1:8320 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6066
Mailing Address - Country:US
Mailing Address - Phone:317-882-5122
Mailing Address - Fax:
Practice Address - Street 1:1450 DOWELL SPRINGS BLVD STE 300
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2444
Practice Address - Country:US
Practice Address - Phone:865-637-8812
Practice Address - Fax:865-637-8865
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32575363LF0000X
IN71008310A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily