Healthcare Provider Details

I. General information

NPI: 1073519260
Provider Name (Legal Business Name): LISA H TOMLIN MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 125B
HARTFORD CT
06106-5501
US

IV. Provider business mailing address

1290 SILAS DEANE HWY
WETHERSFIELD CT
06109-4337
US

V. Phone/Fax

Practice location:
  • Phone: 254-449-2906
  • Fax:
Mailing address:
  • Phone: 254-449-2906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13093
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: