=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952076564
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA MARGARET SARKISIAN APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2021
-----------------------------------------------------
Last Update Date | 01/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 FOXON RD
-----------------------------------------------------
City | EAST HAVEN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06513-2038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 475-441-7809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 HAMMOCK PKWY
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06413-2304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-304-3499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 9897
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------