Provider Demographics
NPI:1104849553
Name:CORRADINO, JOAN (APRN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:CORRADINO
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 1:1216 FARMINGTON AVE
Mailing Address - Street 2:ROOM 102
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2672
Mailing Address - Country:US
Mailing Address - Phone:860-561-1007
Mailing Address - Fax:860-561-1222
Practice Address - Street 1:1216 FARMINGTON AVE
Practice Address - Street 2:ROOM 102
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2672
Practice Address - Country:US
Practice Address - Phone:860-561-1007
Practice Address - Fax:860-561-1222
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002269363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004262929Medicaid
CT004262929Medicaid
CTQ71364Medicare UPIN