Provider Demographics
NPI:1427795970
Name:JAKUBA, ADELINA NICOLE (MS, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ADELINA
Middle Name:NICOLE
Last Name:JAKUBA
Suffix:
Gender:F
Credentials:MS, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 DAYTON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4279
Mailing Address - Country:US
Mailing Address - Phone:860-271-2400
Mailing Address - Fax:
Practice Address - Street 1:5 DAYTON RD STE 102
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4279
Practice Address - Country:US
Practice Address - Phone:860-271-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT147591163WN0800X
CTPENDING363LF0000X
CT10960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience