Healthcare Provider Details

I. General information

NPI: 1033497029
Provider Name (Legal Business Name): NINA S MAKARIDINA HSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PARK STREET 2ND FLOOR OUTPATIENT
NEW HAVEN CT
06519
US

IV. Provider business mailing address

34 PARK STREET 2ND FLOOR OUTPATIEN DEPARTMENT
NEW HAVEN CT
06519
US

V. Phone/Fax

Practice location:
  • Phone: 203-974-7371
  • Fax: 203-974-7322
Mailing address:
  • Phone: 203-974-7371
  • Fax: 203-974-7322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number004663
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4663
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: