Provider Demographics
NPI:1366690380
Name:RENALDI, JACINTA (NP)
Entity Type:Individual
Prefix:
First Name:JACINTA
Middle Name:
Last Name:RENALDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACINTA
Other - Middle Name:
Other - Last Name:PEREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3203 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4225
Mailing Address - Country:US
Mailing Address - Phone:203-371-0009
Mailing Address - Fax:
Practice Address - Street 1:3203 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4225
Practice Address - Country:US
Practice Address - Phone:203-371-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily