Connie Jo Tishner, FNP- C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

71009219A Issued in IN

Practice address

317 Blair Pike
Peru, IN 46970-1507

Phone

(765) 480-9525

NPI assigned

Aug 8, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Longevity Clinical LTC Associates of Indiana, PC

  • Geriatric Medicine (Family Medicine) Physician
  • Indianapolis, IN
  • NPI 1497581250

  Primary Care

  Medicare reassignment NPD

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

{
    "created_epoch": "1565222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1629623392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 BLAIR PIKE",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469701507",
            "telephone_number": "765-480-9525",
            "fax_number": "765-487-5361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 BLAIR PIKE",
            "city": "PERU",
            "state": "IN",
            "postal_code": "469701507",
            "telephone_number": "765-480-9525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISHNER",
        "first_name": "CONNIE",
        "middle_name": "JO",
        "credential": "FNP- C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-08",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "71009219A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Tanner, PHARMD
• Glen Robert Taylor
• Crystal Terry, BS
• The Waters of Peru Skilled Nursing Center LLC
• Betsy E Thompson, BS
• Kendall Toney, PHD, HSPP
• Debra Lynn Turner, COTA
• Luke Ulery
• Mytreyi Varre, RPH
• Vibrant Chiropractic, LLC

• Family Nurse Practitioner in Peru, IN
• Providers in Peru, IN by specialty
• Family Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.