Healthcare Provider Details

I. General information

NPI: 1336324292
Provider Name (Legal Business Name): TAMMY ANN MARQUIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FARMINGTON AVE
FARMINGTON CT
06030-0001
US

IV. Provider business mailing address

PO BOX 206
WASHINGTON DEPOT CT
06794-0206
US

V. Phone/Fax

Practice location:
  • Phone: 869-679-4450
  • Fax:
Mailing address:
  • Phone: 860-868-9158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number003730
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: