Healthcare Provider Details

I. General information

NPI: 1154214286
Provider Name (Legal Business Name): JENNIFER ANNE AVILA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 17TH ST
COLUMBUS IN
47201-5351
US

IV. Provider business mailing address

1117 CHESTNUT ST
COLUMBUS IN
47201-5880
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-5278
  • Fax:
Mailing address:
  • Phone: 812-344-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28285710A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: