Healthcare Provider Details

I. General information

NPI: 1285075788
Provider Name (Legal Business Name): JESSICA MARIE CHRISTOFF APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 FARMINGTON AVE STE 309
FARMINGTON CT
06032-1953
US

IV. Provider business mailing address

23 BROWN ST APT 2R
NEW HAVEN CT
06511-5748
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-5570
  • Fax:
Mailing address:
  • Phone: 203-308-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR231776-2
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5395
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number005395
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: