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General NPI Number Information
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NPI Number | 1255700696
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Entity Type | Individual
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Provider Name | SAMARA AMBROSIO
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Gender | Female
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 400 CAPITAL BLVD FL 3
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City | ROCKY HILL
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State | CT
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Zip | 06067-3576
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Country | US
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Telephone | 888-697-9058
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Fax |
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Provider Business Mailing Address
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Address Line | 8 HARVEST HILL RD
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City | WEST SIMSBURY
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State | CT
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Zip | 06092-2221
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Country | US
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Telephone | 860-882-8857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 006294
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License Number State | CT
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