Provider Demographics
NPI:1629581525
Name:BRANKIEWICZ, JOLANTA (APRN)
Entity Type:Individual
Prefix:MISS
First Name:JOLANTA
Middle Name:
Last Name:BRANKIEWICZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 WOLCOTT RD STE 1
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-2673
Mailing Address - Country:US
Mailing Address - Phone:203-879-7980
Mailing Address - Fax:203-879-7988
Practice Address - Street 1:503 WOLCOTT RD STE 1
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2673
Practice Address - Country:US
Practice Address - Phone:203-879-7980
Practice Address - Fax:203-879-7988
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily