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NPI Code Detail

MEDICARE: JENNA STARR FLECK AGPCNP-BC

MEDICARE: JENNA STARR FLECK AGPCNP-BC
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
1163W00000XRegistered Nurse201042875RNOR
2363L00000XNurse Practitioner201801692NP-PPOR
3363L00000XNurse Practitioner71011196AIN

General Provider Information

NPI Number : 1891211058
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA STARR FLECK AGPCNP-BC
Provider Business Mailing Address
First Line : 10700 PARK PL
Second Line :
City : SAINT JOHN
State : IN
Zip : 46373-8666
Country : US
Telephone Number : 800-509-2800
Fax Number : 219-365-3524
Provider Business Practice Location Address
First Line : 10700 PARK PL
Second Line :
City : SAINT JOHN
State : IN
Zip : 46373-8666
Country : US
Telephone Number : 800-509-2800
Fax Number : 219-365-3524
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2017
Last Update Date : 05/09/2023

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Directions to “ JENNA STARR FLECK AGPCNP-BC” Practice Location

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