Healthcare Provider Details

I. General information

NPI: 1730070251
Provider Name (Legal Business Name): JENNA MARIE INDINGARO BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E CHERRY ST
SPRINGFIELD MO
65897-3402
US

IV. Provider business mailing address

4100 MONTEIGNE DR
PENSACOLA FL
32504-4443
US

V. Phone/Fax

Practice location:
  • Phone: 417-836-5039
  • Fax:
Mailing address:
  • Phone: 603-391-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: