Provider Demographics
NPI:1851819601
Name:BUSSOLARI, SARAH CAITLIN (APRN)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CAITLIN
Last Name:BUSSOLARI
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 1:41 FOX DEN RD
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2219
Mailing Address - Country:US
Mailing Address - Phone:413-977-1216
Mailing Address - Fax:
Practice Address - Street 1:22 PINE ST STE 104
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6949
Practice Address - Country:US
Practice Address - Phone:860-584-8291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7167363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner