Provider Demographics
NPI:1275028896
Name:STOUT, JACLYN GROGAN (FNP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:GROGAN
Last Name:STOUT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HHC CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-5507
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:499 FARMINGTON AVE STE 2B
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1943
Practice Address - Country:US
Practice Address - Phone:860-947-8500
Practice Address - Fax:860-524-8643
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342661363LF0000X
CT14883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily