Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 6865 | CT |
N | 363LP2300X | Nurse Practitioner - Primary Care | 6865 | CT |
NPI | 1063956480 |
---|---|
Provider Name | Holly Fitzgerald |
First Address | Southington, CT 06489-4149 |
Second Address | Bristol, CT 06010-4068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2016 |
Last Update Date | 06/03/2017 |