Provider Demographics
NPI:1427077460
Name:RUGG, JACQUELINE (APRN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:RUGG
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 1:3074 WHITNEY AVE
Mailing Address - Street 2:BUILDING 1; 2ND FLOOR
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-2391
Mailing Address - Country:US
Mailing Address - Phone:203-287-2400
Mailing Address - Fax:203-453-9684
Practice Address - Street 1:3074 WHITNEY AVE
Practice Address - Street 2:BUILDING 1; 2ND FLOOR
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-2391
Practice Address - Country:US
Practice Address - Phone:203-287-2400
Practice Address - Fax:203-453-9684
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000077363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT187096OtherMHN
CTP2743620OtherOXFORD
CT163026OtherVALUE OPTIONS
CT400000077CT-02OtherBLUE CROSS BLUE SHIELD
890000027Medicare ID - Type Unspecified