Provider Demographics
NPI:1003668864
Name:SPIEGEL, JENNIE MIRIAM (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:MIRIAM
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MORGAN ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5458
Mailing Address - Country:US
Mailing Address - Phone:860-966-5517
Mailing Address - Fax:
Practice Address - Street 1:260 LONG RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1638
Practice Address - Country:US
Practice Address - Phone:475-619-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101167163W00000X
CT13232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse