Provider Demographics
NPI:1053436378
Name:MARKIEWICZ, JESSICA ANN (PA- C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:MARKIEWICZ
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:A
Other - Last Name:ABO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13500 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13500 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1456
Practice Address - Country:US
Practice Address - Phone:317-582-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000715A363AM0700X, 207RC0000X, 207RI0011X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000559016OtherANTHEM
IN000000559016OtherANTHEM
INP00475189Medicare PIN