Healthcare Provider Details

I. General information

NPI: 1063818425
Provider Name (Legal Business Name): ROLINDA MITCHELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1711
US

IV. Provider business mailing address

31 OLD ROUTE 7
BROOKFIELD CT
06804-1711
US

V. Phone/Fax

Practice location:
  • Phone: 781-817-4676
  • Fax:
Mailing address:
  • Phone: 475-253-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2292040
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number431943
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2292040
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11515
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: