Provider Demographics
NPI:1275866857
Name:CHRISTOFORI, JULIA (APRN)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:CHRISTOFORI
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 1:57 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-5286
Mailing Address - Country:US
Mailing Address - Phone:860-645-1100
Mailing Address - Fax:860-533-0041
Practice Address - Street 1:57 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-5286
Practice Address - Country:US
Practice Address - Phone:860-645-1100
Practice Address - Fax:860-533-0041
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004151363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061496224OtherTAX ID