MEDICARE: MRS. JENNIFER SAGGARS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10000628A	IN

General Provider Information

NPI Number	:	1457765059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER SAGGARS PA-C

Provider Business Mailing Address
First Line	:	1620 W PERRY RD
Second Line	:
City	:	LIGONIER
State	:	IN
Zip	:	46767-9505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5010 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6804
Country	:	US
Telephone Number	:	260-436-1248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	06/12/2014

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