Provider Demographics
NPI:1235186255
Name:PASACRETA, JEANNIE VIRGINIA (APRN, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANNIE
Middle Name:VIRGINIA
Last Name:PASACRETA
Suffix:
Gender:F
Credentials:APRN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ABBEY LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2784
Mailing Address - Country:US
Mailing Address - Phone:203-270-0080
Mailing Address - Fax:203-304-1191
Practice Address - Street 1:4 ABBEY LN
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:CT
Practice Address - Zip Code:06470-2784
Practice Address - Country:US
Practice Address - Phone:203-270-0080
Practice Address - Fax:203-304-1191
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001359363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004253738Medicaid
CTQ59438Medicare UPIN