Healthcare Provider Details

I. General information

NPI: 1316122484
Provider Name (Legal Business Name): JESSICA H. FORTUNAK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 N CAPITOL AVE STE 236
INDIANAPOLIS IN
46202-1262
US

IV. Provider business mailing address

26 RIDGELINE DR
BROWNSBURG IN
46112-8832
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-8067
  • Fax: 317-962-3796
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71002547A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: