Healthcare Provider Details

I. General information

NPI: 1801588819
Provider Name (Legal Business Name): YAZMILIE GOMEZ CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2023
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CONNECTICUT BLVD
EAST HARTFORD CT
06108
US

IV. Provider business mailing address

94 CONNECTICUT BLVD
EAST HARTFORD CT
06108
US

V. Phone/Fax

Practice location:
  • Phone: 860-528-1359
  • Fax: 860-290-4142
Mailing address:
  • Phone: 413-885-2555
  • Fax: 860-222-7643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2310505
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.136965
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number16.000612
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number16.000612
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: