Individual provider Active NPI

Marissa Jean Tanasi, APRN

  • Family Nurse Practitioner
  • Bristol, CT
National Provider Identifier
1285490789
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
12892 Issued in CT
Practice address
625 Clark Ave
Bristol, CT 06010-4068
Phone
(860) 583-7700
Fax
(860) 589-7656
NPI assigned
Feb 22, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 12892 CT Primary

Addresses

Primary practice location

625 Clark Ave
Bristol, CT 06010-4068

Mailing address

7 Florence LN
Plainville, CT 06062-1018
Phone (860) 706-4140

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240314002141 CT Practitioner - Nurse Practitioner 5193161925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prohealth Physicians PCGroup PAC ID 1355246950, 214 clinicians

Practice addresses (Care Compare)

625 Clark Ave
Bristol, CT 06010-4068
Phone (860) 583-7700

Hospital & facility affiliations

  • Hartford Healthcare at Home Home health agency, East Hartford, CT, CCN 077041
  • Bristol Hospital Hospital, Bristol, CT, CCN 070029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12892CTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Physicians PC Family CurrentSince Mar 11, 2024 Accepting new patients

Locations

1251 Farmington Ave
Bristol, CT 06010
Phone (860) 584-4535

625 Clark Ave
Bristol, CT 06010
Phone (860) 583-7700

3 Farm Glen Blvd
Farmington, CT 06032
Phone (860) 284-5200

115 Spencer St
Winsted, CT 06098
Phone (860) 738-5810

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1708560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1285490789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 FLORENCE LN",
            "city": "PLAINVILLE",
            "state": "CT",
            "postal_code": "060621018",
            "telephone_number": "860-706-4140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 CLARK AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060104068",
            "telephone_number": "860-583-7700",
            "fax_number": "860-589-7656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANASI",
        "first_name": "MARISSA",
        "middle_name": "JEAN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-22",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "12892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, CT

Sources for this page

Verify at the official NPI Registry.