Healthcare Provider Details

I. General information

NPI: 1659209930
Provider Name (Legal Business Name): MICHAEL TIRINZONI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 HAMAN CT
BERLIN CT
06037-3559
US

IV. Provider business mailing address

47 HAMAN CT
BERLIN CT
06037-3559
US

V. Phone/Fax

Practice location:
  • Phone: 860-463-9949
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.016862
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: