Perez, Jacqueline Nicole

Perez, Jacqueline Nicole is an individual health care provider with primary practice located at 385 W Main St , Avon CT 06001-4357. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Perez, Jacqueline Nicole can be contacted via phone (860) 777-1280.

Contact Information

Primary practice address
385 W Main St Avon CT 06001-4357
Phone: (860) 777-1280
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 60363705 Washington
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9106924 Florida
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 4631 Connecticut

Profile Details

NPI number 1407108558
LBN Legal business name Perez, Jacqueline Nicole
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 12th, 2012
Last updated May 7th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407108558 NPPES
Connecticut Other 004613 CT LIC
Connecticut MEDICAID 007207500 CT LIC
Connecticut MEDICAID 003128788A CT LIC

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