Healthcare Provider Details

I. General information

NPI: 1265023071
Provider Name (Legal Business Name): DOROTHY JESSICA PEREZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 LAFAYETTE ST
NEW BRITAIN CT
06051-1803
US

IV. Provider business mailing address

67 HICKORY ST
BRISTOL CT
06010-4348
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-3642
  • Fax:
Mailing address:
  • Phone: 860-270-9034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9514
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number086972
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: