Healthcare Provider Details

I. General information

NPI: 1730077975
Provider Name (Legal Business Name): JACQUELINE STRATOUDAKIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0002
US

IV. Provider business mailing address

39 NEWELL HILL RD
ELLINGTON CT
06029-2816
US

V. Phone/Fax

Practice location:
  • Phone: 860-371-6126
  • Fax:
Mailing address:
  • Phone: 860-371-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number157634
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15024
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: