Healthcare Provider Details

I. General information

NPI: 1386642437
Provider Name (Legal Business Name): LUZ ENEIDA FISCHER-FLORES MSN, APRN,ANP,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EXECUTIVE BLVD
SOUTHINGTON CT
06489-1058
US

IV. Provider business mailing address

18 JAMESTOWN CT
GLASTONBURY CT
06033-3923
US

V. Phone/Fax

Practice location:
  • Phone: 860-296-2790
  • Fax:
Mailing address:
  • Phone: 860-659-3865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number001810
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: