Healthcare Provider Details

I. General information

NPI: 1942665443
Provider Name (Legal Business Name): TRINA PATENAUDE MARTIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 LASALLE RD STE 300
WEST HARTFORD CT
06107-2311
US

IV. Provider business mailing address

225 BOSTON POST RD UNIT 38
EAST LYME CT
06333-7002
US

V. Phone/Fax

Practice location:
  • Phone: 518-598-5220
  • Fax: 866-383-6746
Mailing address:
  • Phone: 860-494-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number6394
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6394
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: