Healthcare Provider Details

I. General information

NPI: 1689373615
Provider Name (Legal Business Name): ANA CRISTINA PEREZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 MAIN ST
EAST HARTFORD CT
06118-1823
US

IV. Provider business mailing address

113 BARRY CIR
BLOOMFIELD CT
06002-1976
US

V. Phone/Fax

Practice location:
  • Phone: 860-548-6899
  • Fax:
Mailing address:
  • Phone: 860-548-6899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number152405
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number11714
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: