Provider Demographics
NPI:1396896601
Name:MULLIN, AMY C (FNP-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:MULLIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 MCCALLIE AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3256
Mailing Address - Country:US
Mailing Address - Phone:423-698-0850
Mailing Address - Fax:423-698-0511
Practice Address - Street 1:2339 MCCALLIE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3256
Practice Address - Country:US
Practice Address - Phone:423-698-0850
Practice Address - Fax:423-698-0511
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012399363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF0806230OtherNP CERTIFICATION
TNRN0000119811OtherRN LICENSE
TNAPN0000012399OtherADVANCED PRACTICE NURSE
GARN171509OtherRN LICENSE
GARN171509OtherRN LICENSE