Provider Demographics
NPI:1619040417
Name:HEATH, LORISSA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LORISSA
Middle Name:
Last Name:HEATH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 EASTERN BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4353
Mailing Address - Country:US
Mailing Address - Phone:860-246-4260
Mailing Address - Fax:860-430-9770
Practice Address - Street 1:98 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2500
Practice Address - Country:US
Practice Address - Phone:860-246-4260
Practice Address - Fax:860-430-9770
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily