Healthcare Provider Details

I. General information

NPI: 1245531771
Provider Name (Legal Business Name): HOLLIE SUZANNE SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HYDE AVE STE 109
VERNON CT
06066-4503
US

IV. Provider business mailing address

9 BISHOP RD
OXFORD CT
06478-1597
US

V. Phone/Fax

Practice location:
  • Phone: 860-454-0303
  • Fax: 860-875-4242
Mailing address:
  • Phone: 866-881-0979
  • Fax: 203-643-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number004550
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number004550
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: