Provider Demographics
NPI:1962179275
Name:MURILLO, JACQUELINE MARISOL (DNP- APRN)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MARISOL
Last Name:MURILLO
Suffix:
Gender:F
Credentials:DNP- APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 THREE MILE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1713
Mailing Address - Country:US
Mailing Address - Phone:203-850-0758
Mailing Address - Fax:
Practice Address - Street 1:456 THREE MILE HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-1713
Practice Address - Country:US
Practice Address - Phone:203-850-0758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000000000000000363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology