Provider Demographics
NPI:1023257714
Name:DRISCOLL, CAREY REYNHOLDS (NP)
Entity type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:REYNHOLDS
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:CAREY
Other - Middle Name:BETH
Other - Last Name:REYNHOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:505 FARMINGTON AVE, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-837-6700
Mailing Address - Fax:860-837-6745
Practice Address - Street 1:505 FARMINGTON AVE, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-837-6700
Practice Address - Fax:860-837-6745
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382007363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics