Provider Demographics
NPI:1134462070
Name:SITZMAN, JENNIFER N (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:SITZMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:N
Other - Last Name:PROVENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-3363
Mailing Address - Fax:812-450-3071
Practice Address - Street 1:415 W COLUMBIA ST
Practice Address - Street 2:STE 110
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1656
Practice Address - Country:US
Practice Address - Phone:812-450-3363
Practice Address - Fax:812-450-3071
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004395A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200188920Medicaid
IN639880005Medicare PIN