MEDICARE: MRS. LORISSA HEATH APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	003138	CT

General Provider Information

NPI Number	:	1619040417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORISSA HEATH APRN

Provider Business Mailing Address
First Line	:	195 EASTERN BLVD STE 201
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-4353
Country	:	US
Telephone Number	:	860-246-4260
Fax Number	:	860-430-9770

Provider Business Practice Location Address
First Line	:	98 MAIN ST STE 203
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2500
Country	:	US
Telephone Number	:	860-246-4260
Fax Number	:	860-430-9770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/29/2021

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