Individual
JACQUELINE BRAUNWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
68 DIVISION ST, DERBY, CT 06418-1447
(203) 732-6802
(203) 732-6792
Mailing address
68 DIVISION ST, DERBY, CT 06418-1447
(203) 732-6802
(203) 732-6792
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003273
CT
363AM0700X
Medical Physician Assistant
Primary
003273
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649665936
—
CT
Enumeration date
04/02/2015
Last updated
10/19/2022
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