Provider Demographics
NPI:1902050016
Name:GUARDIA, JACQUELINE M (NP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:M
Last Name:GUARDIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 N BENSON RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5195
Mailing Address - Country:US
Mailing Address - Phone:203-254-4000
Mailing Address - Fax:203-254-4263
Practice Address - Street 1:1073 N BENSON RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5195
Practice Address - Country:US
Practice Address - Phone:203-254-4000
Practice Address - Fax:203-254-4263
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6017363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health