Healthcare Provider Details

I. General information

NPI: 1306043062
Provider Name (Legal Business Name): JILL V. TESEI A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILL T VAUGHAN APRN

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 EAST PUTNAM AVE. 2ND FLOOR SUITE 1
COS COB CT
06807
US

IV. Provider business mailing address

399 EAST PUTNAM AVE. 2ND FLOOR SUITE 1
COS COB CT
06807
US

V. Phone/Fax

Practice location:
  • Phone: 203-906-6016
  • Fax:
Mailing address:
  • Phone: 203-906-6016
  • Fax: 203-454-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCTAPRN002891
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number002891
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number002891
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: