Provider Demographics
NPI:1275669079
Name:TARGGART, JAYNE LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:LEE
Last Name:TARGGART
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 TILLER DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-1304
Mailing Address - Country:US
Mailing Address - Phone:219-762-6135
Mailing Address - Fax:
Practice Address - Street 1:909 TILLER DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-1304
Practice Address - Country:US
Practice Address - Phone:219-762-6135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002111A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200868760Medicaid
INQ56029Medicare UPIN
IN200868760Medicaid