Healthcare Provider Details

I. General information

NPI: 1518476647
Provider Name (Legal Business Name): SEQUILLA CARTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2017
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 BARNARD LN STE 311
BLOOMFIELD CT
06002-2495
US

IV. Provider business mailing address

35 POST OFFICE PARK STE 3504
WILBRAHAM MA
01095-1186
US

V. Phone/Fax

Practice location:
  • Phone: 860-458-4759
  • Fax: 504-226-0721
Mailing address:
  • Phone: 413-596-6922
  • Fax: 413-596-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number166902
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2361143
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number65000
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95520
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8679
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: