Provider Demographics
NPI:1386201606
Name:TANTILLO, MEGAN BURNS (DNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:BURNS
Last Name:TANTILLO
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:ANN
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:1051 FARMINGTON AVE UNIT A-2
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-1572
Mailing Address - Country:US
Mailing Address - Phone:860-940-0900
Mailing Address - Fax:
Practice Address - Street 1:1051 FARMINGTON AVE UNIT A-2
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-1572
Practice Address - Country:US
Practice Address - Phone:860-940-0900
Practice Address - Fax:860-253-2898
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT124970163W00000X
CT10163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse