Healthcare Provider Details

I. General information

NPI: 1366993164
Provider Name (Legal Business Name): CONSTANDINA PATRICIA CONLEY APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 TALCOTTVILLE RD SUITE 5
VERNON CT
06066-5261
US

IV. Provider business mailing address

35 TALCOTTVILLE RD SUITE 5
VERNON CT
06066
US

V. Phone/Fax

Practice location:
  • Phone: 860-870-6388
  • Fax: 860-870-0635
Mailing address:
  • Phone: 860-870-6388
  • Fax: 860-870-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6783
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number6783
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number6783
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: