Healthcare Provider Details

I. General information

NPI: 1659025112
Provider Name (Legal Business Name): SARAH K GUEVARA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N MAIN ST
ENFIELD CT
06082-3372
US

IV. Provider business mailing address

19 GRAND ST
MIDDLETOWN CT
06457-2705
US

V. Phone/Fax

Practice location:
  • Phone: 860-253-9024
  • Fax: 860-253-9593
Mailing address:
  • Phone: 860-347-6971
  • Fax: 860-343-7378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16668
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1069746
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: