Provider Demographics
NPI:1992716898
Name:VIOLETTE, JENNIFER A (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:VIOLETTE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3 FARM GLEN BLVD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1981
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:8D CANAL CT
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3747
Practice Address - Country:US
Practice Address - Phone:860-674-9686
Practice Address - Fax:860-674-9954
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ25721Medicare UPIN