Provider Demographics
NPI:1710656657
Name:MULLINS, TINA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 THOROUGHBRED LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-7588
Mailing Address - Country:US
Mailing Address - Phone:177-603-3883
Mailing Address - Fax:
Practice Address - Street 1:609 THOROUGHBRED LN
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-7588
Practice Address - Country:US
Practice Address - Phone:177-603-3883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INAG09210075363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner