Provider Demographics
NPI:1285809319
Name:REMIGIO MANDAC, JENNIFER (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:REMIGIO MANDAC
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 1:25 HIDDEN PINES CIR
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2212
Mailing Address - Country:US
Mailing Address - Phone:203-634-1470
Mailing Address - Fax:
Practice Address - Street 1:10 PROGRESS DRIVE SUITE 200
Practice Address - Street 2:NP CARE LLC
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6216
Practice Address - Country:US
Practice Address - Phone:203-925-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily