Provider Demographics
NPI:1649157140
Name:SRINIVASAN, MARGARET ANN (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ANN
Last Name:SRINIVASAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:ANN
Other - Last Name:SRINIVASAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP BC
Mailing Address - Street 1:1625 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-7103
Mailing Address - Country:US
Mailing Address - Phone:574-255-1400
Mailing Address - Fax:
Practice Address - Street 1:1625 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-7103
Practice Address - Country:US
Practice Address - Phone:574-255-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN4185345363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health