Healthcare Provider Details

I. General information

NPI: 1952076564
Provider Name (Legal Business Name): JESSICA SARKISIAN PECEVICH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 WATERVILLE RD
AVON CT
06001-2097
US

IV. Provider business mailing address

1 DAVIS FARM RD
CLINTON CT
06413-1374
US

V. Phone/Fax

Practice location:
  • Phone: 860-284-0182
  • Fax:
Mailing address:
  • Phone: 860-304-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9897
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: