Provider Demographics
NPI:1871878090
Name:GOOCH, JAMIE KATE (APRN)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:KATE
Last Name:GOOCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:HINCHLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:158 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-4417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF CONNECTICUT HEALTH CTR
Practice Address - Street 2:263 FARMINGTON AVE.
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-2000
Practice Address - Fax:860-679-1843
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004832363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1871878090Medicaid