Healthcare Provider Details

I. General information

NPI: 1265348064
Provider Name (Legal Business Name): JUAN CARLOS TORVISCO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 HAZELNUT HILL RD
GROTON CT
06340-3268
US

IV. Provider business mailing address

35 PROSPECT ST
NORWICH CT
06360-4729
US

V. Phone/Fax

Practice location:
  • Phone: 860-446-8265
  • Fax:
Mailing address:
  • Phone: 860-222-5449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number188921
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: