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General NPI Number Information
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NPI Number | 1275028896
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Entity Type | Individual
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Provider Name | JACLYN GROGAN STOUT FNP
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Gender | Female
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 499 FARMINGTON AVE STE 2B
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City | FARMINGTON
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State | CT
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Zip | 06032-1943
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Country | US
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Telephone | 860-947-8500
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Fax | 860-524-8643
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Provider Business Mailing Address
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Address Line | 1290 SILAS DEANE HWY HHC CVO
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City | WETHERSFIELD
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State | CT
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Zip | 06109-4337
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Country | US
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Telephone | 860-972-5507
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Fax | 860-972-7040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 342661
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 14883
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License Number State | CT
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