Provider Demographics
NPI:1033497029
Name:MAKARIDINA, NINA S (HSN, APRN)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:S
Last Name:MAKARIDINA
Suffix:
Gender:F
Credentials:HSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PARK STREET
Mailing Address - Street 2:2ND FLOOR OUTPATIEN DEPARTMENT
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519
Mailing Address - Country:US
Mailing Address - Phone:203-974-7371
Mailing Address - Fax:203-974-7322
Practice Address - Street 1:34 PARK STREET
Practice Address - Street 2:2ND FLOOR OUTPATIENT
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519
Practice Address - Country:US
Practice Address - Phone:203-974-7371
Practice Address - Fax:203-974-7322
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004663363L00000X
CT4663363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health