Provider Demographics
NPI:1063914232
Name:DOSSANTOS, JAMIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:DOSSANTOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SQUANTUCK RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2124
Mailing Address - Country:US
Mailing Address - Phone:203-231-6909
Mailing Address - Fax:
Practice Address - Street 1:39 SQUANTUCK RD
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2124
Practice Address - Country:US
Practice Address - Phone:203-231-6909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner