Provider Demographics
NPI:1295251254
Name:CONBOY, JENNIFER LAGOSZ (APRN FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LAGOSZ
Last Name:CONBOY
Suffix:
Gender:F
Credentials:APRN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WINTERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1816
Mailing Address - Country:US
Mailing Address - Phone:860-841-5432
Mailing Address - Fax:
Practice Address - Street 1:1216 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2672
Practice Address - Country:US
Practice Address - Phone:860-561-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.007185207QA0505X
CT7185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine