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NPI Code Detail

MEDICARE: THAMARA VANESSA JONATHAS APRN

MEDICARE: THAMARA VANESSA JONATHAS APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner7176CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750894275
Entity Type Code : Individual
Provider Name (Legal Business Name) : THAMARA VANESSA JONATHAS APRN
Provider Business Mailing Address
First Line : 1007 N MAIN ST
Second Line :
City : DAYVILLE
State : CT
Zip : 06241-2170
Country : US
Telephone Number : 860-774-2020
Fax Number : 860-477-4708
Provider Business Practice Location Address
First Line : 140 N FRONTAGE RD
Second Line :
City : MANSFIELD CENTER
State : CT
Zip : 06250-1648
Country : US
Telephone Number : 860-456-2261
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2017
Last Update Date : 03/27/2023

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