Provider Demographics
NPI:1306159306
Name:HARTMAN, JENNIFER (ANP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:13450 N MERIDIAN ST STE 135
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13450 N MERIDIAN ST STE 135
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1546
Practice Address - Country:US
Practice Address - Phone:317-582-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003428A363LA2200X
IN28180192A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000684728OtherANTHEM
IN200995760Medicaid
INP01270956OtherRR MEDICARE
ININ1663024Medicare PIN
INP01270956OtherRR MEDICARE
INM400026249Medicare PIN