Provider Demographics
NPI:1134172265
Name:FLYNN, JENNIFER (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FLYNN
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 1:139 HAZARD AVE
Mailing Address - Street 2:BUILDING 4 SUITE 14
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4585
Mailing Address - Country:US
Mailing Address - Phone:860-763-0208
Mailing Address - Fax:860-763-0224
Practice Address - Street 1:139 HAZARD AVE
Practice Address - Street 2:BUILDING 4 SUITE 14
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4585
Practice Address - Country:US
Practice Address - Phone:860-763-0208
Practice Address - Fax:860-763-0224
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003283363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400003283CT01OtherBLUE CROSS
CT032830OtherCONNECTICARE
CT500001592Medicare ID - Type Unspecified
CT400003283CT01OtherBLUE CROSS