Healthcare Provider Details

I. General information

NPI: 1760856827
Provider Name (Legal Business Name): HEATHER JOLICOEUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PARK LANE RD STE A203
NEW MILFORD CT
06776-2445
US

IV. Provider business mailing address

170 MOUNT PLEASANT RD STE 201
NEWTOWN CT
06470-1476
US

V. Phone/Fax

Practice location:
  • Phone: 203-792-4151
  • Fax: 203-792-4155
Mailing address:
  • Phone: 203-792-4151
  • Fax: 203-792-4155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003396
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: