Individual
TINA L HARRISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
9669 E. 146TH STREET, SUITE 200, NOBLESVILLE, IN 46060-5004
(317) 621-6300
(317) 621-6310
Mailing address
6626 E. 75TH STREET, SUITE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-6333
(317) 621-6310
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01051078A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000312975
ANTHEM
IN
05
—
200307830
—
IN
01
—
P00138522
MEDICARE RAILROAD
IN
Enumeration date
08/03/2006
Last updated
11/27/2023
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