Healthcare Provider Details

I. General information

NPI: 1285182402
Provider Name (Legal Business Name): BROOKE GOUVEIA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2016
Last Update Date: 11/18/2022
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-4038
US

IV. Provider business mailing address

263 FARMINGTON AVE
FARMINGTON CT
06030-4038
US

V. Phone/Fax

Practice location:
  • Phone: 860-679-6662
  • Fax: 860-679-1432
Mailing address:
  • Phone: 860-679-6662
  • Fax: 860-679-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6667
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number6667
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6667
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: