Healthcare Provider Details

I. General information

NPI: 1942736293
Provider Name (Legal Business Name): TARYN K BISHOP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARYN K O'BRIEN

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 08/14/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 W MAIN ST
AVON CT
06001-4357
US

IV. Provider business mailing address

1290 SILAS DEANE HIGHWAY HHC - CVO
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 860-777-1280
  • Fax: 860-777-1276
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN43764
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01625
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10456
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: