Provider Demographics
NPI:1285035303
Name:RAUSCH, TIMOTHY (RN, MSN, FNP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:RAUSCH
Suffix:
Gender:M
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 BOSTON POST RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-4335
Mailing Address - Country:US
Mailing Address - Phone:203-453-9911
Mailing Address - Fax:
Practice Address - Street 1:1591 BOSTON POST RD STE 100
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4335
Practice Address - Country:US
Practice Address - Phone:203-453-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001138363LF0000X
CT6419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95001138OtherNURSE PRACTITIONER LICENSE