Provider Demographics
NPI:1245071646
Name:SURMA, JESSICA ANN (RN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANN
Last Name:SURMA
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6345 E 250 N
Mailing Address - Street 2:
Mailing Address - City:GROVERTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46531-9312
Mailing Address - Country:US
Mailing Address - Phone:219-851-0532
Mailing Address - Fax:
Practice Address - Street 1:601 W KIEFFER RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9599
Practice Address - Country:US
Practice Address - Phone:219-878-9870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015306A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner