Provider Demographics
NPI:1477563922
Name:ALLEN, PATRICIA JACKSON (APRN PNP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JACKSON
Last Name:ALLEN
Suffix:
Gender:F
Credentials:APRN PNP
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:LUDDER
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN MS PNP
Mailing Address - Street 1:20 ACORN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CT
Mailing Address - Zip Code:06525
Mailing Address - Country:US
Mailing Address - Phone:203-737-2345
Mailing Address - Fax:203-785-6455
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:YNHH PRIMARY CARE CENTER
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510
Practice Address - Country:US
Practice Address - Phone:203-737-2345
Practice Address - Fax:203-785-6455
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002773363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics