Healthcare Provider Details

I. General information

NPI: 1861422735
Provider Name (Legal Business Name): CAROLINE TASSEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 BLAIR PARK RD SUITE 210
WILLISTON VT
05495-7886
US

IV. Provider business mailing address

33 HOLLY LN
BURLINGTON VT
05408-2621
US

V. Phone/Fax

Practice location:
  • Phone: 802-598-4006
  • Fax: 802-316-4208
Mailing address:
  • Phone: 802-540-0388
  • Fax: 802-316-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number101-0016244
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number101-0016244
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number101-0016244
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: