Provider Demographics
NPI:1366671026
Name:SMITH, JASON G (APRN)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:APRN
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Mailing Address - Street 1:7365 MAIN ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-1300
Mailing Address - Country:US
Mailing Address - Phone:203-384-3072
Mailing Address - Fax:203-384-4619
Practice Address - Street 1:267 GRANT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-2805
Practice Address - Country:US
Practice Address - Phone:203-384-3072
Practice Address - Fax:203-384-4619
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT004146363L00000X
CT071219367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner