Individual provider Active NPI

Jany Perez Pedraza, ARNP

  • Family Nurse Practitioner
  • Fort Wayne, IN
National Provider Identifier
1154280741
Registry record updated Jun 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F12250671 Issued in FL
Practice address
3919 W Jefferson Blvd Ste 2
Fort Wayne, IN 46804-6811
Phone
(260) 450-1313
Fax
(855) 583-3606
NPI assigned
Jan 19, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F12250671 FL Primary
Family Nurse Practitioner 363LF0000X 71017867A IN

Addresses

Primary practice location

3919 W Jefferson Blvd Ste 2
Fort Wayne, IN 46804-6811

Mailing address

3919 W Jefferson Blvd Ste 2
Fort Wayne, IN 46804-6811
Phone (260) 436-7722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260331000989 IN Practitioner - Nurse Practitioner 1759866403 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson Park Pediatrics P CGroup PAC ID 2961748991, 4 clinicians

Practice addresses (Care Compare)

3919 W Jefferson Blvd
2 Jefferson Medical
Fort Wayne, IN 46804-6811
Phone (260) 450-1313

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
F12250671FLMDFamily Nurse Practitioner

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1768780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781568000000",
    "number": "1154280741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD STE 2",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-436-7722",
            "fax_number": "855-583-3606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3919 W JEFFERSON BLVD STE 2",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046811",
            "telephone_number": "260-450-1313",
            "fax_number": "855-583-3606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ PEDRAZA",
        "first_name": "JANY",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-01-19",
        "last_updated": "2026-06-16",
        "certification_date": "2026-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "F12250671",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71017867A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

Verify at the official NPI Registry.