Healthcare Provider Details

I. General information

NPI: 1033414867
Provider Name (Legal Business Name): STEVEN PAUL JESKE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2011
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 HIGHLAND AVE STE A2
WATERBURY CT
06708
US

IV. Provider business mailing address

276 HIGHLAND AVE STE A2
WATERBURY CT
06708-3022
US

V. Phone/Fax

Practice location:
  • Phone: 203-819-7220
  • Fax: 203-819-7270
Mailing address:
  • Phone: 203-518-5232
  • Fax: 888-372-6480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number004592
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: