Healthcare Provider Details

I. General information

NPI: 1033754924
Provider Name (Legal Business Name): JESSICA GAMBARDELLA APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AUDUBON ST
NEW HAVEN CT
06511-6433
US

IV. Provider business mailing address

96 HATTERTOWN RD
NEWTOWN CT
06470-2449
US

V. Phone/Fax

Practice location:
  • Phone: 203-562-7662
  • Fax:
Mailing address:
  • Phone: 631-806-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8594
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: