MEDICARE: ANDREA S BARLETTA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	002419	CT

General Provider Information

NPI Number	:	1730187634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA S BARLETTA APRN

Provider Business Mailing Address
First Line	:	699 SHENIPSIT LAKE RD
Second Line	:
City	:	TOLLAND
State	:	CT
Zip	:	06084-2032
Country	:	US
Telephone Number	:	860-558-0245
Fax Number	:

Provider Business Practice Location Address
First Line	:	699 SHENIPSIT LAKE RD
Second Line	:
City	:	TOLLAND
State	:	CT
Zip	:	06084-2032
Country	:	US
Telephone Number	:	860-558-0245
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	09/03/2021

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