Healthcare Provider Details

I. General information

NPI: 1316198534
Provider Name (Legal Business Name): YVONNE L JOY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YVONNE L LATAILLE

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SHUNPIKE RD
CROMWELL CT
06416-2442
US

IV. Provider business mailing address

25 KNOLL RIDGE CT
MIDDLETOWN CT
06457-2145
US

V. Phone/Fax

Practice location:
  • Phone: 860-539-5262
  • Fax:
Mailing address:
  • Phone: 860-347-3065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number003819
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3819
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: