Provider Demographics
NPI:1053628784
Name:MARTINS, JESSICA VAZ (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:VAZ
Last Name:MARTINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 HAWLEY LANE
Mailing Address - Street 2:STE 002
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611
Mailing Address - Country:US
Mailing Address - Phone:203-375-3456
Mailing Address - Fax:203-380-3803
Practice Address - Street 1:160 HAWLEY LN STE 2
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5387
Practice Address - Country:US
Practice Address - Phone:203-375-3456
Practice Address - Fax:203-380-3803
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002445363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical