Provider Demographics
NPI:1891338166
Name:LANTZ, JAYME (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JAYME
Middle Name:
Last Name:LANTZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20085 TURQUOISE LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-6294
Mailing Address - Country:US
Mailing Address - Phone:574-612-2524
Mailing Address - Fax:
Practice Address - Street 1:2936 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3914
Practice Address - Country:US
Practice Address - Phone:574-306-2145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-19
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009510A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily