Healthcare Provider Details

I. General information

NPI: 1194123869
Provider Name (Legal Business Name): HEIDI ANN JOSEPH DNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2014
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WOODLAND ST
HARTFORD CT
06105-1207
US

IV. Provider business mailing address

47 DAY POINT RD
EAST HAMPTON CT
06424-1523
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-5949
  • Fax:
Mailing address:
  • Phone: 860-714-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberE59721
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberE59721
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License NumberE59721
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberE59721
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: