Provider Demographics
NPI:1457161663
Name:VINCENT, BEATRICE HOME
Entity type:Individual
Prefix:
First Name:BEATRICE
Middle Name:HOME
Last Name:VINCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 MOUNT FAIR DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-1657
Mailing Address - Country:US
Mailing Address - Phone:203-224-9376
Mailing Address - Fax:
Practice Address - Street 1:317 FOXON RD
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-2038
Practice Address - Country:US
Practice Address - Phone:475-441-7809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT14017207Q00000X, 163WG0000X, 208D00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice