Provider Demographics
NPI:1639170681
Name:NUGENT, PATRICIA (PA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:NUGENT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2313
Mailing Address - Country:US
Mailing Address - Phone:860-258-3470
Mailing Address - Fax:860-571-6800
Practice Address - Street 1:1260 SILAS DEANE HWY
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4362
Practice Address - Country:US
Practice Address - Phone:860-258-2375
Practice Address - Fax:860-571-6805
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001196363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970001069Medicare ID - Type Unspecified
CTP62112Medicare UPIN