Provider Demographics
NPI:1568191260
Name:HOOSOCK, CAITLIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:HOOSOCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9179 RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-9620
Mailing Address - Country:US
Mailing Address - Phone:315-882-8753
Mailing Address - Fax:
Practice Address - Street 1:9179 RIVERSIDE RD
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-9620
Practice Address - Country:US
Practice Address - Phone:315-882-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349660363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty