Jillian Ann Hacker, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

36003377A Issued in IN

Practice address

3946 Ice Way
Fort Wayne, IN 46805-1018

Phone

(260) 444-2788

NPI assigned

Jul 25, 2018

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

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1962989640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8813 GULF DR APT B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468253092",
            "telephone_number": "765-524-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3946 ICE WAY",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468051018",
            "telephone_number": "260-444-2788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKER",
        "first_name": "JILLIAN",
        "middle_name": "ANN",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-25",
        "last_updated": "2020-09-03",
        "certification_date": "2020-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36003377A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOC",
            "identifier": "2000038863",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA PROFESSIONAL LICENSING AGENCY",
            "identifier": "36003377A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "jillianhacker2018@gmail.com",
            "affiliation": "N",
            "address_1": "3946 Ice Way",
            "city": "Fort Wayne",
            "state": "IN",
            "country_code": "US",
            "postal_code": "468051018",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sajjad H Habib, MD
• Zeenat Habibullah, MD
• Taquoia Hackbush
• Tia Hackbush, RBT, BS
• Jessica Lynn Hackenberg, PSY.D.
• Emily Nicole Hackett
• Kari Louise Hackley, NP
• Hade Home Healthcare LLC
• Annmarie Haemmerle, PA-C
• Logan Haffner, RBT

• Athletic Trainer in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Athletic Trainer in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.