Healthcare Provider Details

I. General information

NPI: 1609789460
Provider Name (Legal Business Name): JAZMYN NICHOLS MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 FRANKLIN ST
MICHIGAN CITY IN
46360-7397
US

IV. Provider business mailing address

3939 FRANKLIN ST
MICHIGAN CITY IN
46360-7397
US

V. Phone/Fax

Practice location:
  • Phone: 219-878-5850
  • Fax:
Mailing address:
  • Phone: 219-878-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71018720A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: