Healthcare Provider Details

I. General information

NPI: 1033945951
Provider Name (Legal Business Name): BETH-ANNE LYN ROY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOEFFLER RD
BLOOMFIELD CT
06002-2256
US

IV. Provider business mailing address

4 SILVER LN
ENFIELD CT
06082-5823
US

V. Phone/Fax

Practice location:
  • Phone: 860-380-5150
  • Fax:
Mailing address:
  • Phone: 413-297-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number12.014010
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: