Provider Demographics
NPI:1760016778
Name:BOGAN, ERICA LYNN (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:LYNN
Last Name:BOGAN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BOLT LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2001
Mailing Address - Country:US
Mailing Address - Phone:203-685-1898
Mailing Address - Fax:
Practice Address - Street 1:3272 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4819
Practice Address - Country:US
Practice Address - Phone:203-380-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily