Healthcare Provider Details

I. General information

NPI: 1760115620
Provider Name (Legal Business Name): JENNIFER SOTO AGPCNP - APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S COUNTY TRL STE 1A
EAST GREENWICH RI
02818-5081
US

IV. Provider business mailing address

455 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-7290
  • Fax: 401-921-6194
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN05278
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN05278
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: