Provider Demographics
NPI:1679537757
Name:MOKOTOFF, HEATHER (APRN, MSN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MOKOTOFF
Suffix:
Gender:F
Credentials:APRN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OLD DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4967
Mailing Address - Country:US
Mailing Address - Phone:203-583-2534
Mailing Address - Fax:
Practice Address - Street 1:50 OLD DAIRY RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4967
Practice Address - Country:US
Practice Address - Phone:203-583-2534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003261363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics