Provider Demographics
NPI:1396158226
Name:GUERRA, JACQUELYNE MICHELLE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:JACQUELYNE
Middle Name:MICHELLE
Last Name:GUERRA
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NORTHROP RD
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1997
Mailing Address - Country:US
Mailing Address - Phone:203-949-1534
Mailing Address - Fax:
Practice Address - Street 1:900 NORTHROP RD
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1997
Practice Address - Country:US
Practice Address - Phone:203-949-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT090372163W00000X
CT5735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse