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General NPI Number Information
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NPI Number | 1003487604
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Entity Type | Individual
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Provider Name | JENNIFER MARIE SPORS NP
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Gender | Female
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Dates
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Enumeration Date | 07/05/2021
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Last Update Date | 02/16/2026
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Provider Practice Location Address
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Address Line | 550 UNIVERSITY BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5149
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Country | US
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Telephone | 317-944-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AG09200205
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71011253A
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License Number State | IN
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