Healthcare Provider Details

I. General information

NPI: 1285164111
Provider Name (Legal Business Name): SARAH ELAINE YIZNITSKY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 MAIN ST STE 205
HARTFORD CT
06120-1936
US

IV. Provider business mailing address

245 GEORGE WOOD RD
SOMERS CT
06071-1409
US

V. Phone/Fax

Practice location:
  • Phone: 860-400-2550
  • Fax: 860-400-2551
Mailing address:
  • Phone: 860-810-0987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2328282
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNJDCATEMP-006820
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number007142
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: