Provider Demographics
NPI:1992501290
Name:YACELGA, JEAN PAULA (APRN)
Entity type:Individual
Prefix:
First Name:JEAN PAULA
Middle Name:
Last Name:YACELGA
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 1:720 KETTLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4628
Mailing Address - Country:US
Mailing Address - Phone:203-592-1602
Mailing Address - Fax:860-590-3921
Practice Address - Street 1:966 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1645
Practice Address - Country:US
Practice Address - Phone:860-736-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT014481363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health