Provider Demographics
NPI:1760490676
Name:MCCRACKEN TURCOTTE, JEAN ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:JEAN ANNE
Middle Name:
Last Name:MCCRACKEN TURCOTTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RETREAT AVE STE 811
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2528
Mailing Address - Country:US
Mailing Address - Phone:860-522-5712
Mailing Address - Fax:860-548-0031
Practice Address - Street 1:100 RETREAT AVE STE 811
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-522-5712
Practice Address - Fax:860-548-0031
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000440363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
774837OtherCT
290000440CTOtherANTHEM
P3212157OtherOXFORD
00122950900OtherEDS BLUE CARE
2V0031OtherHEALTH NET
880000007Medicare ID - Type Unspecified
00122950900OtherEDS BLUE CARE