Provider Demographics
NPI:1497887855
Name:GOSS, HOLLY J (MSN CNS APRN)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:J
Last Name:GOSS
Suffix:
Gender:F
Credentials:MSN CNS APRN
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-6243
Mailing Address - Country:US
Mailing Address - Phone:203-733-1816
Mailing Address - Fax:203-283-7857
Practice Address - Street 1:203 BROAD ST
Practice Address - Street 2:UNIT C-4
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4750
Practice Address - Country:US
Practice Address - Phone:203-733-1816
Practice Address - Fax:203-283-7857
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000963363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S58803Medicare UPIN
890000478Medicare ID - Type Unspecified