Healthcare Provider Details

I. General information

NPI: 1871831735
Provider Name (Legal Business Name): ISMAELE LING JACQUES APN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2013
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST NP4-202
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

20 YORK ST NP4-202
NEW HAVEN CT
06510-3220
US

V. Phone/Fax

Practice location:
  • Phone: 203-200-4822
  • Fax: 203-200-2099
Mailing address:
  • Phone: 203-200-4822
  • Fax: 203-200-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5195
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP012496
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: