Healthcare Provider Details

I. General information

NPI: 1871164509
Provider Name (Legal Business Name): HEATHER HOSKINS HENRY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2021
Last Update Date: 04/07/2023
Certification Date: 04/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HAZEL TER STE 20
WOODBRIDGE CT
06525-2240
US

IV. Provider business mailing address

438 LITTLE MEADOW RD
GUILFORD CT
06437-2065
US

V. Phone/Fax

Practice location:
  • Phone: 203-293-7763
  • Fax:
Mailing address:
  • Phone: 303-229-5968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number108555
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11841
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: