Provider Demographics
NPI:1366476293
Name:JIN, CAROL LEE (APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LEE
Last Name:JIN
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:MS
Other - First Name:CAROL
Other - Middle Name:LEE
Other - Last Name:JIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC
Mailing Address - Street 1:400 CAPITAL BLVD
Mailing Address - Street 2:SUITE 3-134
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3576
Mailing Address - Country:US
Mailing Address - Phone:860-930-3342
Mailing Address - Fax:
Practice Address - Street 1:400 CAPITAL BLVD
Practice Address - Street 2:SUITE 3-134
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3576
Practice Address - Country:US
Practice Address - Phone:860-930-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003433363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care