Healthcare Provider Details

I. General information

NPI: 1659166510
Provider Name (Legal Business Name): VANITY TATTOO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 VIRGINIA AVE # 208
INDIANAPOLIS IN
46203-1712
US

IV. Provider business mailing address

1028 VIRGINIA AVE # 208
INDIANAPOLIS IN
46203-1712
US

V. Phone/Fax

Practice location:
  • Phone: 407-982-4876
  • Fax: 407-650-2754
Mailing address:
  • Phone: 407-982-4876
  • Fax: 407-650-2754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER WILLIAMS
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-982-4876