Provider Demographics
NPI:1942047618
Name:SCHILKE, JESSICA (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SCHILKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PERKINS FARM DR STE 301
Mailing Address - Street 2:
Mailing Address - City:MYSTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06355-4041
Mailing Address - Country:US
Mailing Address - Phone:860-572-5400
Mailing Address - Fax:860-245-0001
Practice Address - Street 1:100 PERKINS FARM DR STE 301
Practice Address - Street 2:
Practice Address - City:MYSTIC
Practice Address - State:CT
Practice Address - Zip Code:06355-4041
Practice Address - Country:US
Practice Address - Phone:860-572-5400
Practice Address - Fax:860-245-0001
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.013468363L00000X
CT13468363LG0600X
RIAPRN04189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology