Healthcare Provider Details

I. General information

NPI: 1376435610
Provider Name (Legal Business Name): TASHEAKA JONES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COLUMBUS AVE
NEW HAVEN CT
06519-1233
US

IV. Provider business mailing address

151 PARK TER
WATERBURY CT
06708-3589
US

V. Phone/Fax

Practice location:
  • Phone: 203-503-3000
  • Fax:
Mailing address:
  • Phone: 203-994-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14904
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number14904
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: