Healthcare Provider Details

I. General information

NPI: 1558155614
Provider Name (Legal Business Name): CHARLOTTE CROSS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLIE CROSS DNP

II. Dates (important events)

Enumeration Date: 04/05/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALBANY AVE
HARTFORD CT
06120-2508
US

IV. Provider business mailing address

500 ALBANY AVE
HARTFORD CT
06120-2508
US

V. Phone/Fax

Practice location:
  • Phone: 860-249-9625
  • Fax: 860-808-1537
Mailing address:
  • Phone: 860-249-9625
  • Fax: 860-808-1537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.016583
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0137763
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: