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COLLABORATIVE MEDICINE LLC
NPI 1063137511
Nurse Practitioner - Family in Canton, CT

Active since October 06, 2022CLIA 07D2274619 · Waiver
166 ALBANY TPKE STE 7, CANTON, CT 06019(860) 935-6680(860) 359-3701 Get Directions Write a Review

NPPES record last updated: May 22, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 22, 2025, Feb 14, 2025, Dec 6, 2022 and 1 more (4 updates tracked since 2022).

About Collaborative Medicine Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

COLLABORATIVE MEDICINE LLC (NPI 1063137511) is a healthcare organization registered as a family in Canton, Connecticut and active in the NPI registry since October 2022. The organization holds a CLIA Waiver certificate valid through January 8, 2027, maintains a secondary practice location in Burlington, and lists Jennifer Cannon, Owner, as its authorized official.

NPPES Registry Identity

NPI1063137511
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameCOLLABORATIVE MEDICINE LLC
Location Address166 ALBANY TPKE STE 7Canton, CT 06019-2546
Mailing Address78 Pine Hill RdBurlington, CT 06013-2303 · (203) 444-0436
Phone(860) 935-6680
Fax(860) 359-3701
Organization SubpartNo
Authorized OfficialJennifer CannonOwner · (860) 935-6680
Enumeration DateOctober 6, 2022
Last NPPES UpdateMay 22, 20254 updates tracked since enumeration
NPPES CertifiedMay 22, 2025
✔ NPI 1063137511 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
166 ALBANY TPKE STE 7, Canton, CT 06019
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Secondary Practice Location 1

Location 178 Pine Hill RdBurlington, CT 06013-2303 · Phone (203) 910-1577

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 07D2274619

Collaborative Medicine LLC · Canton, CT
Active · expires Jan 8, 2027
CLIA Number07D2274619
Laboratory TypePractitioner Other
Certificate Effective DateJanuary 9, 2025
Certificate Expiration DateJanuary 8, 2027
Laboratory DirectorJennifer Cannon Aprn
Laboratory Phone(860) 935-6680
Laboratory LocationCollaborative Medicine LLC166 Albany Turnpike, Ste 7, Canton, CT 06019
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JENNIFER CANNON APRN
Nurse Practitioner (Family)
166 ALBANY TPKE STE 7
CANTON, CT 06019
Capitol Planning Region (860) 935-6680

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Collaborative Medicine LLC's NPI number?

The NPI number for Collaborative Medicine LLC is 1063137511. It was assigned to this organization in the NPPES registry on October 6, 2022.

Where is Collaborative Medicine LLC located?

Collaborative Medicine LLC is located at 166 Albany Tpke Ste 7, Canton, CT 06019. The listed phone number is (860) 935-6680.

What is Collaborative Medicine LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Collaborative Medicine LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 07D2274619) is associated with this NPI, valid through January 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Collaborative Medicine LLC was last updated on May 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.