Healthcare Provider Details

I. General information

NPI: 1164133591
Provider Name (Legal Business Name): FRANCINE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 FARMINGTON AVE
BRISTOL CT
06010-4752
US

IV. Provider business mailing address

1168 FARMINGTON AVE
BRISTOL CT
06010-4752
US

V. Phone/Fax

Practice location:
  • Phone: 888-674-3444
  • Fax:
Mailing address:
  • Phone: 888-674-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: