Individual
JANICE TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
439 MILL HILL AVE, BRIDGEPORT, CT 06610-2866
(203) 334-2100
Mailing address
146 E GATE LN, HAMDEN, CT 06514-2234
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
107221
CT
363L00000X
Nurse Practitioner
Primary
8408
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/09/2019
Last updated
08/22/2019
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