MEDICARE: JEAN K EVANGELISTI 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
1	363LA2200X	Adult Health Nurse Practitioner	002284	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	400002284CT01	OTHER	DE	ANTHEM- INSURANCE
2	705146	OTHER	CT	CONNECTICARE - INSURANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760464903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN K EVANGELISTI APRN

Provider Business Mailing Address
First Line	:	780 LITCHFIELD ST
Second Line	:	SUITE 200
City	:	TORRINGTON
State	:	CT
Zip	:	06790-6268
Country	:	US
Telephone Number	:	860-489-1984
Fax Number	:	860-496-2195

Provider Business Practice Location Address
First Line	:	780 LITCHFIELD ST
Second Line	:	SUITE 200
City	:	TORRINGTON
State	:	CT
Zip	:	06790-6268
Country	:	US
Telephone Number	:	860-489-1984
Fax Number	:	860-496-2195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	07/23/2010

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Directions to “ JEAN K EVANGELISTI APRN” Practice Location

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