Provider Demographics
NPI:1104341908
Name:PROVENZANO, BRITTANY (RN, NP)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:PROVENZANO
Suffix:
Gender:
Credentials:RN, NP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:TARTAGLIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6 WILLIAMSBURG DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2507
Mailing Address - Country:US
Mailing Address - Phone:203-650-3168
Mailing Address - Fax:
Practice Address - Street 1:795 BRIDGEPORT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484
Practice Address - Country:US
Practice Address - Phone:860-650-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2342809363LF0000X
NY348683363LF0000X
CT7356363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily