Individual provider Active NPI

Amanda Marie Pacheco, APRN

  • Family Nurse Practitioner
  • Hartford, CT
National Provider Identifier
1881171635
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
12.007706 Issued in CT
Practice address
114 Woodland St
Hartford, CT 06105-1208
Phone
(860) 714-4270
NPI assigned
Jul 24, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN.CNP.0042322 OH
Family Nurse Practitioner 363LF0000X 12.007706 CT Primary
Family Nurse Practitioner 363LF0000X 4704448904 MI

Addresses

Primary practice location

114 Woodland St
Hartford, CT 06105-1208

Mailing address

505 Buckland Dr
Cheshire, CT 06410-4153
Phone (203) 233-8935

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, MI, OH3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20190716000263 CT Practitioner - Nurse Practitioner 4880929702 Reassigns benefits to 1 organization
I20260605001987 MI Practitioner - Nurse Practitioner 4880929702 Reassigns benefits to 1 organization
I20260623004342 OH Practitioner - Nurse Practitioner 4880929702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

200 Oceangate
Suite 100
Long Beach, CA 90802-4316

505 Buckland Dr
Cheshire, CT 06410-4153

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
12.007706CTMDFamily Nurse Practitioner
4704448904MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Molina Care Connections, LLC. CurrentSince Jan 26, 2026 Accepting new patients

Locations

200 Oceangate
Ste 100
Long Beach, CA 90802
Phone (562) 435-3666

175 Scott Swamp Rd
Farmington, CT 06032
Phone (860) 249-6752

880 W Long Lake Rd
Troy, MI 48098
Phone (248) 227-6316

3000 Corporate Exchange Dr
Columbus, OH 43231
Phone (614) 942-3042

Interoperability endpoints

  • Direct secure messaging: ms_apache30@landmarkhealth-direct.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781481600000",
    "number": "1881171635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 BUCKLAND DR",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064104153",
            "telephone_number": "203-233-8935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 WOODLAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051208",
            "telephone_number": "860-714-4270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACHECO",
        "first_name": "AMANDA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-24",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "APRN.CNP.0042322",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "12.007706",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704448904",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.