=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730039231
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MALLORY JANE AQUILA APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2026
-----------------------------------------------------
Last Update Date | 02/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 MAIN ST CRITICAL CARE
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06606-4292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 475-210-5663
-----------------------------------------------------
Fax | 475-210-6512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1051 NEW ROCK HILL RD
-----------------------------------------------------
City | WALLINGFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06492-2623
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-530-1179
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 15050
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------