Healthcare Provider Details

I. General information

NPI: 1558238345
Provider Name (Legal Business Name): LIFESPAN ADVANCED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 MEDICAL DR
CARMEL IN
46032-3323
US

IV. Provider business mailing address

11313 USA PKWY STE E148
FISHERS IN
46037-9208
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-4211
  • Fax:
Mailing address:
  • Phone: 317-781-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. LEA ANN RENEE SPENCER
Title or Position: DIRECTOR OF CLINICAL SERVICES
Credential: APRN
Phone: 812-568-1374