Individual
JAKE PETILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 GRAND ST, NEW BRITAIN, CT 06052-2016
(860) 224-5011
Mailing address
245 W CENTER ST, SOUTHINGTON, CT 06489-3550
(203) 217-3143
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
12761
CT
Other
Enumeration date
01/05/2024
Last updated
01/05/2024
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