Healthcare Provider Details

I. General information

NPI: 1154280741
Provider Name (Legal Business Name): JANY PEREZ PEDRAZA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 W JEFFERSON BLVD STE 2
FORT WAYNE IN
46804-6811
US

IV. Provider business mailing address

3919 W JEFFERSON BLVD STE 2
FORT WAYNE IN
46804-6811
US

V. Phone/Fax

Practice location:
  • Phone: 260-450-1313
  • Fax: 855-583-3606
Mailing address:
  • Phone: 260-436-7722
  • Fax: 855-583-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF12250671
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71017867A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: