Healthcare Provider Details

I. General information

NPI: 1427484708
Provider Name (Legal Business Name): SYRMA I MIDDLEBROOK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 TAMARACK AVE STE 102
SOUTH WINDSOR CT
06074-5553
US

IV. Provider business mailing address

2639 MAIN ST
GLASTONBURY CT
06033-2023
US

V. Phone/Fax

Practice location:
  • Phone: 860-648-0860
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number005468
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: