Provider Demographics
NPI:1861422735
Name:TASSEY, CAROLINE (NP)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:TASSEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05408-2621
Mailing Address - Country:US
Mailing Address - Phone:802-540-0388
Mailing Address - Fax:802-316-4208
Practice Address - Street 1:277 BLAIR PARK RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7886
Practice Address - Country:US
Practice Address - Phone:802-598-4006
Practice Address - Fax:802-316-4208
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101-0016244363LA2200X, 363LP0200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONP0855Medicaid
VTONPO855Medicaid
S47226Medicare UPIN