Healthcare Provider Details

I. General information

NPI: 1659457638
Provider Name (Legal Business Name): PAULA C ROCHA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HYDE AVE STE 109
VERNON CT
06066-4503
US

IV. Provider business mailing address

30 JORDAN LN
WETHERSFIELD CT
06109-1278
US

V. Phone/Fax

Practice location:
  • Phone: 860-454-0303
  • Fax: 860-875-4242
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2601
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number002601
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: