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General NPI Number Information
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NPI Number | 1497315956
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Entity Type | Individual
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Provider Name | JENA MITCHELL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 520 SAYBROOK RD STE 105
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City | MIDDLETOWN
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State | CT
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Zip | 06457-4700
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Country | US
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Telephone | 860-740-8132
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Fax |
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Provider Business Mailing Address
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Address Line | 281 HARTFORD TPKE STE 201
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City | VERNON
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State | CT
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Zip | 06066-4759
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Country | US
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Telephone | 860-558-4226
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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 | 8229
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License Number State | CT
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