Healthcare Provider Details

I. General information

NPI: 1396558128
Provider Name (Legal Business Name): TERESA JEAN MARKS FNP-C, APRN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 N MAIN ST STE A
WATERBURY CT
06704-2364
US

IV. Provider business mailing address

PO BOX 745254
ATLANTA GA
30374-5254
US

V. Phone/Fax

Practice location:
  • Phone: 203-951-8306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14320
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: