Provider Demographics
NPI:1447663240
Name:ROSSA, JENNIFER L (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:ROSSA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:ABBOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9011 N MERIDIAN ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5378
Mailing Address - Country:US
Mailing Address - Phone:317-564-2134
Mailing Address - Fax:317-574-4737
Practice Address - Street 1:8330 NAAB RD
Practice Address - Street 2:SUITE 234
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5925
Practice Address - Country:US
Practice Address - Phone:317-875-0084
Practice Address - Fax:317-876-5580
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005028A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner