Healthcare Provider Details

I. General information

NPI: 1437037827
Provider Name (Legal Business Name): JESSICA CRESPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GAYLORD FARM RD
WALLINGFORD CT
06492-2899
US

IV. Provider business mailing address

50 GAYLORD FARM RD
WALLINGFORD CT
06492-2899
US

V. Phone/Fax

Practice location:
  • Phone: 203-284-2800
  • Fax: 203-294-8764
Mailing address:
  • Phone: 203-284-2802
  • Fax: 203-294-8764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License Number017647
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number017647
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: