Healthcare Provider Details

I. General information

NPI: 1083427017
Provider Name (Legal Business Name): BRIGID AGNES SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WAHOO AVE
GROTON CT
06349-2324
US

IV. Provider business mailing address

1 WAHOO AVE
GROTON CT
06349-2324
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-7557
  • Fax: 860-694-1330
Mailing address:
  • Phone: 860-694-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024192460
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15747
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: