COLLABORATIVE MEDICINE LLC NPI 1063137511

NPI Information

  • NPI: 1063137511
  • Provider Name: COLLABORATIVE MEDICINE LLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 07D2274619
  • Address: 166 ALBANY TPKE STE 7
    CANTON, CT
    ZIP 06019
  • Phone: (860) 935-6680

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NPI Details

COLLABORATIVE MEDICINE LLC is a family nurse practitioner in Canton, CT. COLLABORATIVE MEDICINE LLC NPI is 1063137511. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

166 ALBANY TPKE STE 7
CANTON, CT
ZIP 06019-546
Phone: (860) 935-6680
Fax: (860) 359-3701

The provider's authorized official is Jennifer Cannon .
The authorized official title is Owner and has the following contact phone number (860) 935-6680.

The CLIA number assigned to this NPI record is 07D2274619 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/6/2022 and was last updated on 5/22/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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