Provider Demographics
NPI:1811970866
Name:TAGLIAVINI, LYNDA B (APRN)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:B
Last Name:TAGLIAVINI
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 1:149 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-3006
Mailing Address - Country:US
Mailing Address - Phone:860-668-5013
Mailing Address - Fax:860-297-2020
Practice Address - Street 1:300 SUMMIT ST
Practice Address - Street 2:TRINITY COLLEGE HEALTH CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3100
Practice Address - Country:US
Practice Address - Phone:860-297-2018
Practice Address - Fax:860-297-2020
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000692363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics