Healthcare Provider Details

I. General information

NPI: 1639262579
Provider Name (Legal Business Name): JANE ELIZABETH CLARK RNCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 E BROADWAY
MILFORD CT
06460-6215
US

IV. Provider business mailing address

675 TOWER AVE SUITE 301
HARTFORD CT
06112-1273
US

V. Phone/Fax

Practice location:
  • Phone: 860-490-0800
  • Fax: 888-222-1049
Mailing address:
  • Phone: 860-714-2750
  • Fax: 860-714-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number001952
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1952
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: