Individual provider Active NPI

Jenna Taft, CPNP-PC

  • Pediatric Nurse Practitioner
  • Springfield, IL
National Provider Identifier
1902551328
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
209027315 Issued in IL
Practice address
2532 Farragut Dr
Springfield, IL 62704-1433
Phone
(217) 528-7541
NPI assigned
Feb 14, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 31209 TN
Pediatric Nurse Practitioner 363LP0200X 209027315 IL Primary

Addresses

Primary practice location

2532 Farragut Dr
Springfield, IL 62704-1433

Mailing address

PO Box 19248
Springfield, IL 62794-9248
Phone (217) 528-7541

Other practice location 1

1272 Garrison Dr
Murfreesboro, TN 37129-2598
Phone (615) 893-4480

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220401002204 TN Practitioner - Nurse Practitioner 4981090834 Reassigns benefits to 1 organization
I20230705001616 IL Practitioner - Nurse Practitioner 4981090834 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
31209TNMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Murfreesboro Medical Clinic, P.a. Current Accepting new patients
Springfield Clinic, LLP CurrentSince Jul 5, 2023 Accepting new patients

Locations

775 Engineering Ave
Springfield, IL 62703
Phone (217) 522-4300

2532 Farragut Dr
Springfield, IL 62704
Phone (217) 787-9424

3501 Old Jacksonville Rd
Springfield, IL 62711
Phone (217) 960-8193

1272 Garrison Dr
Murfreesboro, TN 37129
Phone (615) 867-7925

Interoperability endpoints

  • Direct secure messaging: jenna.taft.1@28977.direct.athenahealth.com

Organizations & group practices 3

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": "1644796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1902551328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19248",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949248",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2532 FARRAGUT DR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627041433",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1272 Garrison Dr",
            "address_purpose": "LOCATION",
            "city": "Murfreesboro",
            "state": "TN",
            "postal_code": "371292598",
            "country_code": "US",
            "telephone_number": "615-893-4480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAFT",
        "first_name": "JENNA",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-14",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TN",
            "license": "31209",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209027315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.