Individual
RENA JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6 MAIN ST, DURHAM, CT 06422-2126
(860) 349-1058
(860) 358-8652
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4820
(860) 358-8661
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002304
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008016826
—
CT
Enumeration date
09/08/2009
Last updated
04/12/2017
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