Provider Demographics
NPI:1912592601
Name:FONTAINE, SARAH (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:FONTAINE
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-2451
Mailing Address - Country:US
Mailing Address - Phone:860-510-2841
Mailing Address - Fax:
Practice Address - Street 1:49 WELLES ST STE 207
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4205
Practice Address - Country:US
Practice Address - Phone:860-325-2679
Practice Address - Fax:860-316-4064
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily