Healthcare Provider Details

I. General information

NPI: 1700939998
Provider Name (Legal Business Name): CHERYL L JACQUES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 LEDGEBROOK DR STE C
MANSFIELD CENTER CT
06250-1644
US

IV. Provider business mailing address

813 HOPEWELL RD
SOUTH GLASTONBURY CT
06073-2441
US

V. Phone/Fax

Practice location:
  • Phone: 860-833-2657
  • Fax: 860-200-3491
Mailing address:
  • Phone: 860-918-0526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number000761 APRN
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: