MEDICARE: JAIMIE M MACHADO FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	7305	CT
2	363LF0000X	Family Nurse Practitioner	7305	CT

General Provider Information

NPI Number	:	1841700226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIMIE M MACHADO FNP-C

Provider Business Mailing Address
First Line	:	104 ROBIN DR
Second Line	:
City	:	COLLINSVILLE
State	:	CT
Zip	:	06019-3728
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	166 ALBANY TPKE STE 6
Second Line	:
City	:	CANTON
State	:	CT
Zip	:	06019-2546
Country	:	US
Telephone Number	:	860-831-4151
Fax Number	:	860-413-0848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2017
Last Update Date	:	01/16/2024

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