Provider Demographics
NPI:1891346763
Name:HAVIZA, JASON D (NP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:D
Last Name:HAVIZA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N SENATE BLVD STE 2000
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1252
Mailing Address - Country:US
Mailing Address - Phone:317-962-8700
Mailing Address - Fax:317-962-9704
Practice Address - Street 1:1801 N SENATE BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1252
Practice Address - Country:US
Practice Address - Phone:317-962-8700
Practice Address - Fax:317-962-9704
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009383A363LF0000X
IN28216219A163W00000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse