Provider Demographics
NPI:1659725430
Name:HILBURN, TRACY MICHELLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:MICHELLE
Last Name:HILBURN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:MICHELLE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1542 S. BLOOMINGTON ST.
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135
Mailing Address - Country:US
Mailing Address - Phone:765-301-7030
Mailing Address - Fax:765-301-7035
Practice Address - Street 1:1542 S. BLOOMINGTON ST.
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135
Practice Address - Country:US
Practice Address - Phone:765-301-7030
Practice Address - Fax:765-301-7035
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28184763A163W00000X
IN71006663A363L00000X
IN71006674A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner