Healthcare Provider Details

I. General information

NPI: 1528536174
Provider Name (Legal Business Name): BRIANA GWALTNEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 HAZARD AVE STE 103
ENFIELD CT
06082-5437
US

IV. Provider business mailing address

30 JORDAN LN STE 3
WETHERSFIELD CT
06109-1244
US

V. Phone/Fax

Practice location:
  • Phone: 860-962-6600
  • Fax: 860-962-6866
Mailing address:
  • Phone: 860-263-0253
  • Fax: 860-263-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9355568
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14658
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: