Healthcare Provider Details

I. General information

NPI: 1740177583
Provider Name (Legal Business Name): TAYLA RAE VIZZACCO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ROYAL AVE APT 1R
CRANSTON RI
02920-2437
US

IV. Provider business mailing address

6 ROYAL AVE APT 1R
CRANSTON RI
02920-2437
US

V. Phone/Fax

Practice location:
  • Phone: 401-327-2677
  • Fax:
Mailing address:
  • Phone: 401-327-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN67163
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: