Individual
TRACY E MULLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 325, FORT WAYNE, IN 46845-1714
(260) 425-5400
(260) 425-5417
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002116A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000530707
ANTHEM BC/BS
IN
05
—
200821790
—
IN
05
—
2734376
—
OH
Enumeration date
05/13/2006
Last updated
11/15/2022
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