Provider Demographics
NPI:1720568447
Name:VALLE, JENNIFER ANN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:VALLE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-5106
Mailing Address - Country:US
Mailing Address - Phone:203-610-3885
Mailing Address - Fax:
Practice Address - Street 1:800 HOWARD AVE FL 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-785-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7796207X00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery