MEDICARE: JENNIFER CAROL LITTKE AGPCNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71006191A	IN
2	363LG0600X	Gerontology Nurse Practitioner	71006191A	IN
3	363LP2300X	Primary Care Nurse Practitioner	28137871A	IN

General Provider Information

NPI Number	:	1922470970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CAROL LITTKE AGPCNP-BC

Provider Business Mailing Address
First Line	:	2324 BLUEWATER TRL
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-8403
Country	:	US
Telephone Number	:	230-432-7507
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 E STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-4736
Country	:	US
Telephone Number	:	260-267-9498
Fax Number	:	260-739-3618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2015
Last Update Date	:	12/16/2025

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