Healthcare Provider Details

I. General information

NPI: 1104849553
Provider Name (Legal Business Name): JOAN CORRADINO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 FARMINGTON AVE ROOM 102
WEST HARTFORD CT
06107-2672
US

IV. Provider business mailing address

1216 FARMINGTON AVE ROOM 102
WEST HARTFORD CT
06107-2672
US

V. Phone/Fax

Practice location:
  • Phone: 860-561-1007
  • Fax: 860-561-1222
Mailing address:
  • Phone: 860-561-1007
  • Fax: 860-561-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number002269
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: