Individual
JORDAN FICOCELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
800 HOWARD AVE # 2, NEW HAVEN, CT 06519
(203) 785-2571
Mailing address
254 MICA HILL RD, DURHAM, CT 06422-3311
(203) 627-4950
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
12.007724
CT
363LF0000X
Family Nurse Practitioner
Primary
12.007724
CT
Other
Enumeration date
08/01/2018
Last updated
08/16/2018
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