Provider Demographics
NPI:1033120167
Name:NATI, CAROL ANN (APRN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:NATI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2212
Mailing Address - Country:US
Mailing Address - Phone:860-679-7503
Mailing Address - Fax:860-679-1610
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:ORTHOPAEDICS
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-4038
Practice Address - Country:US
Practice Address - Phone:860-679-6600
Practice Address - Fax:860-679-6604
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002946363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1033120167Medicaid
CTQ02826Medicare UPIN
CT1033120167Medicaid