Provider Demographics
NPI:1083688683
Name:MARROCCO, GERALDINE FAHY (APRN)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:FAHY
Last Name:MARROCCO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:DR
Other - First Name:GERALDINE
Other - Middle Name:FAHY
Other - Last Name:MARROCCO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:115 TECHNOLOGY DR
Mailing Address - Street 2:SUITE B 106
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-6337
Mailing Address - Country:US
Mailing Address - Phone:203-576-1737
Mailing Address - Fax:203-334-3841
Practice Address - Street 1:115 TECHNOLOGY DR
Practice Address - Street 2:SUITE B 106
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6337
Practice Address - Country:US
Practice Address - Phone:203-576-1737
Practice Address - Fax:203-334-3841
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00863363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS48904Medicare UPIN