Healthcare Provider Details

I. General information

NPI: 1790038735
Provider Name (Legal Business Name): ELIZABETH KRYNICKI PMHNP-BC APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 WILDCAT RD
BURLINGTON CT
06013-2400
US

IV. Provider business mailing address

28 WILDCAT RD
BURLINGTON CT
06013-2400
US

V. Phone/Fax

Practice location:
  • Phone: 860-877-3986
  • Fax: 413-224-6403
Mailing address:
  • Phone: 860-877-3986
  • Fax: 413-224-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number005160
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number05160
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number066719
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2012006531
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: