Healthcare Provider Details

I. General information

NPI: 1215847447
Provider Name (Legal Business Name): JENNA LEIGH HART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N RITTER AVE
INDIANAPOLIS IN
46219-3095
US

IV. Provider business mailing address

219 E 17TH ST APT 3C
INDIANAPOLIS IN
46202-1579
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-5457
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28297327A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: