Provider Demographics
NPI:1790394518
Name:DELUCIA, JENNA (APRN)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:DELUCIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:761 MAIN AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1080
Mailing Address - Country:US
Mailing Address - Phone:203-846-8885
Mailing Address - Fax:203-846-6032
Practice Address - Street 1:761 MAIN AVE STE 106
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1080
Practice Address - Country:US
Practice Address - Phone:203-846-8885
Practice Address - Fax:203-846-6032
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT164932163W00000X
CT9033363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse