Healthcare Provider Details

I. General information

NPI: 1750600300
Provider Name (Legal Business Name): JESSICA LAURA CAUCHON NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. JESSICA LAURA FITZGERALD

II. Dates (important events)

Enumeration Date: 05/21/2010
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 WASHINGTON ST
HARTFORD CT
06106-3322
US

IV. Provider business mailing address

PO BOX 3001 D56 NEWBORN HEALTH ASSOCIATES
VOORHEES NJ
08043
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-8950
  • Fax: 860-545-8959
Mailing address:
  • Phone: 856-782-3300
  • Fax: 856-504-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number26NJ00289000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number12.5003
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: