Healthcare Provider Details

I. General information

NPI: 1427077460
Provider Name (Legal Business Name): JACQUELINE RUGG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3074 WHITNEY AVE BUILDING 1; 2ND FLOOR
HAMDEN CT
06518-2391
US

IV. Provider business mailing address

3074 WHITNEY AVE BUILDING 1; 2ND FLOOR
HAMDEN CT
06518-2391
US

V. Phone/Fax

Practice location:
  • Phone: 203-287-2400
  • Fax: 203-453-9684
Mailing address:
  • Phone: 203-287-2400
  • Fax: 203-453-9684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number000077
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: