Individual
JACKIE SUZANNE TANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5255 E STOP 11 RD STE 450, INDIANAPOLIS, IN 46237-6342
(317) 865-4800
(317) 865-4806
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002853A
IN
363A00000X
Physician Assistant
—
—
Other
Enumeration date
10/29/2019
Last updated
05/05/2026
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