Healthcare Provider Details

I. General information

NPI: 1083190243
Provider Name (Legal Business Name): SYLWIA TUESTA AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYLWIA SZUMSKA AGPCNP-BC

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 PARK AVE
BLOOMFIELD CT
06002-3207
US

IV. Provider business mailing address

94 CABOT ST
NEW BRITAIN CT
06053-2946
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-9591
  • Fax:
Mailing address:
  • Phone: 860-331-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12.007715
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10.127652
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: