Provider Demographics
NPI:1245437037
Name:PAGNUCCO, JONICA (PA)
Entity type:Individual
Prefix:
First Name:JONICA
Middle Name:
Last Name:PAGNUCCO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JONICA
Other - Middle Name:
Other - Last Name:YERZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:455 LEWIS AVE
Mailing Address - Street 2:STE 221
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-573-9512
Mailing Address - Fax:203-568-2904
Practice Address - Street 1:64 ROBBINS ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2613
Practice Address - Country:US
Practice Address - Phone:203-573-6263
Practice Address - Fax:203-573-6030
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001913363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical