Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack Thomas Egnatz

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1619786704

Jack Thomas Egnatz is a Student in an Organized Health Care Education/Training Program in Bloomington, Indiana. Registered with an NPI since 2025.

In the registry since
2025

Practice location Address checks out

281 W 11th St
Bloomington, IN 47404-3718
Phone: (219) 798-5636
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1619786704
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJanuary 2, 2025
Last updated in NPPESJanuary 2, 2025
Certification dateJanuary 2, 2025
Mailing address281 W 11th St, Bloomington, IN 47404-3718

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