Healthcare Provider Details

I. General information

NPI: 1023926870
Provider Name (Legal Business Name): MRS. TRACY-ANNE ATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 PARK AVE FL 3
BRIDGEPORT CT
06604-2513
US

IV. Provider business mailing address

1475 PARK AVE FL 3
BRIDGEPORT CT
06604-2513
US

V. Phone/Fax

Practice location:
  • Phone: 203-690-6328
  • Fax:
Mailing address:
  • Phone: 203-690-6328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number41986
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: