Provider Demographics
NPI:1326028531
Name:HARVILL, AMY C (APRN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:HARVILL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:C
Other - Last Name:COATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:2139 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2336
Mailing Address - Country:US
Mailing Address - Phone:860-257-4131
Mailing Address - Fax:860-257-4519
Practice Address - Street 1:300 WESTERN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4305
Practice Address - Country:US
Practice Address - Phone:860-657-1920
Practice Address - Fax:860-657-1930
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002557363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004216687Medicaid
CT500002018Medicare PIN
CTP34991Medicare UPIN