Provider Demographics
NPI:1235737081
Name:ERDMAN, JENNIFER (PA)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:
Last Name:ERDMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:21 EASTBROOK BND STE 218
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1546
Mailing Address - Country:US
Mailing Address - Phone:260-407-8007
Mailing Address - Fax:260-407-8005
Practice Address - Street 1:833 PARK EAST BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0785
Practice Address - Country:US
Practice Address - Phone:765-743-4400
Practice Address - Fax:260-407-8005
Is Sole Proprietor?:No
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10003064A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant