Provider Demographics
NPI:1568552826
Name:STRICKLAND, JASON (APRN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:STRICKLAND
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PINE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6948
Mailing Address - Country:US
Mailing Address - Phone:860-584-8291
Mailing Address - Fax:860-584-8354
Practice Address - Street 1:22 PINE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6948
Practice Address - Country:US
Practice Address - Phone:860-584-8291
Practice Address - Fax:860-584-8354
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005510363L00000X
CT5510363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1568552826OtherANTHEM BCBS