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General NPI Number Information
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NPI Number | 1083249429
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Entity Type | Individual
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Provider Name | CECILIA EBAI TAKO CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2020
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 915 ELLA T GRASSO BLVD
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City | NEW HAVEN
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State | CT
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Zip | 06519-5516
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Country | US
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Telephone | 561-444-3512
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Fax |
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Provider Business Mailing Address
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Address Line | 13206 OYSTERCATCHER LN
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City | BOWIE
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State | MD
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Zip | 20720-4766
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Country | US
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Telephone | 240-565-8977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 207210
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R187498
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024186692
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11015301
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 011979
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License Number State | CT
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