Healthcare Provider Details

I. General information

NPI: 1013844786
Provider Name (Legal Business Name): IXSIA N MARTELL-CARDONA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 DAYTON DR
SOUTHINGTON CT
06489-2262
US

IV. Provider business mailing address

193 DAYTON DR
SOUTHINGTON CT
06489-2262
US

V. Phone/Fax

Practice location:
  • Phone: 203-232-9625
  • Fax:
Mailing address:
  • Phone: 203-232-9625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number62083
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number62083
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number62083
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number62083
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: