Provider Demographics
NPI:1265849459
Name:HILL, BRIAN ANTHONY (AGACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ANTHONY
Last Name:HILL
Suffix:
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 FARMINGTON AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1920
Mailing Address - Country:US
Mailing Address - Phone:860-549-8276
Mailing Address - Fax:860-674-8084
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:508-793-6310
Practice Address - Fax:508-334-8628
Is Sole Proprietor?:No
Enumeration Date:2014-07-19
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006501363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS400221083Medicare PIN