Healthcare Provider Details

I. General information

NPI: 1487880217
Provider Name (Legal Business Name): JENNIFER R SEARLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 N HUMISTON DR
BETHANY CT
06524-3171
US

IV. Provider business mailing address

299 WASHINGTON AVE
HAMDEN CT
06518-3026
US

V. Phone/Fax

Practice location:
  • Phone: 203-671-2987
  • Fax:
Mailing address:
  • Phone: 203-288-4288
  • Fax: 203-288-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number004137
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number081988
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4137
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: