Provider Demographics
NPI:1790035012
Name:CONNELLY, TAMARA LEE (APRN)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:LEE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:TAMARA
Other - Middle Name:LEE
Other - Last Name:SCAGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:2202 MILL POND DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074
Mailing Address - Country:US
Mailing Address - Phone:860-394-9792
Mailing Address - Fax:
Practice Address - Street 1:98 SHAKER RD
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2731
Practice Address - Country:US
Practice Address - Phone:413-525-3958
Practice Address - Fax:413-525-3943
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5106363LP0808X
MARN2285565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health