Healthcare Provider Details

I. General information

NPI: 1992501290
Provider Name (Legal Business Name): JEAN PAULA YACELGA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 S MAIN ST
PLANTSVILLE CT
06479-1645
US

IV. Provider business mailing address

720 KETTLETOWN RD
SOUTHBURY CT
06488-4628
US

V. Phone/Fax

Practice location:
  • Phone: 860-736-5386
  • Fax:
Mailing address:
  • Phone: 203-592-1602
  • Fax: 860-590-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number014481
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: