Healthcare Provider Details

I. General information

NPI: 1386555290
Provider Name (Legal Business Name): STEFANIE LYNN COUGHLIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 TALCOTTVILLE RD
VERNON CT
06066-5261
US

IV. Provider business mailing address

119 TRUMBULL LN
SOUTH WINDSOR CT
06074-2370
US

V. Phone/Fax

Practice location:
  • Phone: 959-250-8611
  • Fax: 860-926-2911
Mailing address:
  • Phone: 959-250-8611
  • Fax: 860-926-2911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number10.142859
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: