Provider Demographics
NPI:1134661531
Name:JEROME, JENNIFER MARIA SOUSA (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIA SOUSA
Last Name:JEROME
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 HARTFORD TPKE STE 106
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4760
Mailing Address - Country:US
Mailing Address - Phone:860-375-2227
Mailing Address - Fax:860-603-5080
Practice Address - Street 1:281 HARTFORD TPKE STE 106
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4760
Practice Address - Country:US
Practice Address - Phone:860-375-2227
Practice Address - Fax:860-603-5080
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily