Healthcare Provider Details

I. General information

NPI: 1205918562
Provider Name (Legal Business Name): DIANE WRIGHT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ELM ST
OLD SAYBROOK CT
06475-4105
US

IV. Provider business mailing address

3305 SHADY SUNRISE LOOP
PLANT CITY FL
33565-2268
US

V. Phone/Fax

Practice location:
  • Phone: 860-388-9656
  • Fax:
Mailing address:
  • Phone: 860-639-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number001131
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: