Healthcare Provider Details

I. General information

NPI: 1861040693
Provider Name (Legal Business Name): JENNIFER LEIGH HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W COLFAX AVE STE 400
SOUTH BEND IN
46601-1635
US

IV. Provider business mailing address

7921 PARK MEADOWS CT
BROWNSBURG IN
46112-7850
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax:
Mailing address:
  • Phone: 765-215-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06192495
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: