Provider Demographics
NPI:1336355874
Name:GAVIN, JOCELYNE MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JOCELYNE
Middle Name:MARIE
Last Name:GAVIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 HARBOUR CLOSE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-2836
Mailing Address - Country:US
Mailing Address - Phone:203-915-5273
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:6-7 EAST
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-915-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001344363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical