Provider Demographics
NPI:1114236411
Name:IACCARINO, JODI LYNN (RN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:IACCARINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1401
Mailing Address - Country:US
Mailing Address - Phone:203-457-9401
Mailing Address - Fax:203-457-9291
Practice Address - Street 1:1856 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2101
Practice Address - Country:US
Practice Address - Phone:860-399-0600
Practice Address - Fax:860-399-0600
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE45850163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation