Provider Demographics
NPI:1851440473
Name:SAMUELSON, BROOKE JENNIFER (APRN)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:JENNIFER
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:JENNIFER
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1 CELLINI PL STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-1666
Mailing Address - Country:US
Mailing Address - Phone:203-932-6481
Mailing Address - Fax:203-932-4051
Practice Address - Street 1:450 COLUMBUS BLVD
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-1801
Practice Address - Country:US
Practice Address - Phone:860-878-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003325363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health