Healthcare Provider Details

I. General information

NPI: 1720357676
Provider Name (Legal Business Name): TERESA DRAKO MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ABBOTT TER
WATERBURY CT
06702-1431
US

IV. Provider business mailing address

541 EASTERN ST APT.1
NEW HAVEN CT
06513-1709
US

V. Phone/Fax

Practice location:
  • Phone: 203-755-4870
  • Fax: 203-755-9016
Mailing address:
  • Phone: 203-745-8483
  • Fax: 203-507-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number004855
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: