Healthcare Provider Details

I. General information

NPI: 1851200240
Provider Name (Legal Business Name): CAROL M ORTEGA RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RETREAT AVE STE 500
HARTFORD CT
06106-2581
US

IV. Provider business mailing address

2 MERRIGAN LN
WINDSOR LOCKS CT
06096-1573
US

V. Phone/Fax

Practice location:
  • Phone: 860-837-5207
  • Fax: 860-837-5209
Mailing address:
  • Phone: 860-966-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number151414
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: