Provider Demographics
NPI:1306043062
Name:TESEI, JILL V (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:V
Last Name:TESEI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:T
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:399 EAST PUTNAM AVE.
Mailing Address - Street 2:2ND FLOOR SUITE 1
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807
Mailing Address - Country:US
Mailing Address - Phone:203-906-6016
Mailing Address - Fax:203-454-2447
Practice Address - Street 1:399 EAST PUTNAM AVE.
Practice Address - Street 2:2ND FLOOR SUITE 1
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807
Practice Address - Country:US
Practice Address - Phone:203-906-6016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002891101YM0800X, 364SP0807X
CTCTAPRN002891363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner