Healthcare Provider Details

I. General information

NPI: 1477077469
Provider Name (Legal Business Name): ANDREA L HECKENDORF APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 GREEN HOLLOW RD
DANIELSON CT
06239-3533
US

IV. Provider business mailing address

320 POMFRET ST
PUTNAM CT
06260-1836
US

V. Phone/Fax

Practice location:
  • Phone: 860-779-1865
  • Fax: 860-779-3820
Mailing address:
  • Phone: 860-928-6541
  • Fax: 860-963-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7127
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number7127
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: