Provider Demographics
NPI:1285490789
Name:TANASI, MARISSA JEAN (APRN)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:JEAN
Last Name:TANASI
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 1:7 FLORENCE LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1018
Mailing Address - Country:US
Mailing Address - Phone:860-706-4140
Mailing Address - Fax:
Practice Address - Street 1:625 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-4068
Practice Address - Country:US
Practice Address - Phone:860-583-7700
Practice Address - Fax:860-589-7656
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily