Provider Demographics
NPI:1356797088
Name:SCOTT, JUANITA VERONA (APRN)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:VERONA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 MILL ST
Mailing Address - Street 2:STE 224
Mailing Address - City:EAST BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06023-1159
Mailing Address - Country:US
Mailing Address - Phone:480-862-1700
Mailing Address - Fax:480-718-7643
Practice Address - Street 1:21 GRAND ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1541
Practice Address - Country:US
Practice Address - Phone:860-550-7549
Practice Address - Fax:860-550-7561
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-12
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT6524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily