Healthcare Provider Details

I. General information

NPI: 1023829876
Provider Name (Legal Business Name): TACONIC ESSENTIAL PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S MAIN ST APT 51
RUTLAND VT
05701-4868
US

IV. Provider business mailing address

PO BOX 1280
RUTLAND VT
05701-1280
US

V. Phone/Fax

Practice location:
  • Phone: 802-772-7107
  • Fax: 802-772-9003
Mailing address:
  • Phone: 802-772-7107
  • Fax: 802-772-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW T DAYTON
Title or Position: CO OWNER / PRACTICE MANAGER
Credential: LNA
Phone: 802-772-7107