Healthcare Provider Details

I. General information

NPI: 1447987847
Provider Name (Legal Business Name): REGINA ANN JAMES APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11108 PARKVIEW CIRCLE DR STE 5100
FORT WAYNE IN
46845-1730
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-2800
  • Fax: 260-266-2805
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71012903A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28102081A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: