Healthcare Provider Details

I. General information

NPI: 1427701598
Provider Name (Legal Business Name): JENNAH COLLEEN TENNELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2022
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 S EMERSON AVE
INDIANAPOLIS IN
46237-8601
US

IV. Provider business mailing address

3791 10TH ST BUILDING 1010
EDINBURGH IN
46124-2553
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-1700
  • Fax:
Mailing address:
  • Phone: 812-348-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013124A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: