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General NPI Number Information
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NPI Number | 1336902709
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Entity Type | Individual
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Provider Name | JENNIFER A DELUCIA APRN
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Gender | Female
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 385 W MAIN ST
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City | AVON
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State | CT
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Zip | 06001-4357
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Country | US
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Telephone | 860-777-1280
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Fax | 860-777-1276
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Provider Business Mailing Address
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Address Line | 6 DIANE LN
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City | BRISTOL
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State | CT
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Zip | 06010-7954
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Country | US
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Telephone | 203-525-0266
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13066
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License Number State | CT
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