Provider Demographics
NPI:1285112334
Name:BURKINS, TRICIA LOUISE (FNP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:LOUISE
Last Name:BURKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 N 500 E
Mailing Address - Street 2:
Mailing Address - City:ROLLING PRAIRIE
Mailing Address - State:IN
Mailing Address - Zip Code:46371-9465
Mailing Address - Country:US
Mailing Address - Phone:574-850-9846
Mailing Address - Fax:
Practice Address - Street 1:1861 SOUTH STURDY ROAD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-548-0360
Practice Address - Fax:219-548-0358
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28144139A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily