MEDICARE: MICHELLE LYN TOLBERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	10872	CT
2	363LF0000X	Family Nurse Practitioner	10872	CT

General Provider Information

NPI Number	:	1255050514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYN TOLBERT

Provider Business Mailing Address
First Line	:	505 LONG MOUNTAIN RD
Second Line	:
City	:	NEW MILFORD
State	:	CT
Zip	:	06776-4803
Country	:	US
Telephone Number	:	312-890-9331
Fax Number	:

Provider Business Practice Location Address
First Line	:	141A DANBURY RD
Second Line	:
City	:	NEW MILFORD
State	:	CT
Zip	:	06776-3428
Country	:	US
Telephone Number	:	860-717-0392
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	09/27/2022

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Directions to “ MICHELLE LYN TOLBERT ” Practice Location

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