Provider Demographics
NPI:1134251689
Name:CARLSON, JENNIFER M (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:CARLSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:167 OLD SACHEMS HEAD RD
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3136
Mailing Address - Country:US
Mailing Address - Phone:203-484-7334
Mailing Address - Fax:203-484-7301
Practice Address - Street 1:999 FOXON RD
Practice Address - Street 2:SUITE 36
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1287
Practice Address - Country:US
Practice Address - Phone:203-484-7334
Practice Address - Fax:203-484-7301
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000589363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics