Provider Demographics
NPI:1801841945
Name:HARTMAN, JENNIFER LEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:CADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1626 E STATE ROAD 44
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-4026
Mailing Address - Country:US
Mailing Address - Phone:317-421-2012
Mailing Address - Fax:317-421-2016
Practice Address - Street 1:2158 INTELLIPLEX DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8548
Practice Address - Country:US
Practice Address - Phone:317-392-3651
Practice Address - Fax:317-398-0538
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000688A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN165460CCCMedicare ID - Type Unspecified
INQ24430Medicare UPIN