Provider Demographics
NPI:1912884305
Name:REYES, ELISSA (MSN CCRN ACNPC- AG)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:MSN CCRN ACNPC- AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614-4636
Mailing Address - Country:US
Mailing Address - Phone:203-727-8030
Mailing Address - Fax:
Practice Address - Street 1:402 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-4636
Practice Address - Country:US
Practice Address - Phone:203-727-8030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15037363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care