Provider Demographics
NPI:1386447712
Name:PREFONTAINE, JAMIE (APRN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PREFONTAINE
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 UNIVERSAL DR N STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-3156
Mailing Address - Country:US
Mailing Address - Phone:203-234-5990
Mailing Address - Fax:
Practice Address - Street 1:190 UNIVERSAL DR N STE 101
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-3156
Practice Address - Country:US
Practice Address - Phone:203-234-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-31
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013975363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner