Healthcare Provider Details

I. General information

NPI: 1760353205
Provider Name (Legal Business Name): ELIZABETH HOLMES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE
HAMDEN CT
06517-1209
US

IV. Provider business mailing address

1135 LONG HILL RD
GUILFORD CT
06437-1821
US

V. Phone/Fax

Practice location:
  • Phone: 203-848-1803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number15367
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: