Individual
JANIS A. JAQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
74 PARK RD, WEST HARTFORD, CT 06119-1853
(860) 218-1725
(860) 218-1727
Mailing address
74 PARK RD, WEST HARTFORD, CT 06119-1853
(860) 218-1725
(860) 218-1727
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001743
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001743
LIC NUMBER
CT
Enumeration date
11/21/2006
Last updated
05/23/2012
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