Healthcare Provider Details

I. General information

NPI: 1053436378
Provider Name (Legal Business Name): JESSICA ANN MARKIEWICZ PA- C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA A ABO

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 N MERIDIAN ST
CARMEL IN
46032-1456
US

IV. Provider business mailing address

13500 N MERIDIAN ST
CARMEL IN
46032-1456
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10000715A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number10000715A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number10000715A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000715A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: