Provider Demographics
NPI:1336902709
Name:DELUCIA, JENNIFER A (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:DELUCIA
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 1:6 DIANE LN
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-7954
Mailing Address - Country:US
Mailing Address - Phone:203-525-0266
Mailing Address - Fax:
Practice Address - Street 1:385 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4357
Practice Address - Country:US
Practice Address - Phone:860-777-1280
Practice Address - Fax:860-777-1276
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13066363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily