Provider Demographics
NPI:1447389309
Name:RICCI-COLLINS, NANCY A (PA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:RICCI-COLLINS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:A
Other - Last Name:RICCI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1450 CHAPEL ST
Mailing Address - Street 2:ST. RAPHAEL DEPT. OF SURGERY
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-4405
Mailing Address - Country:US
Mailing Address - Phone:203-789-3501
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:ST. RAPHAEL DEPT. OF SURGERY
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-3501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000398363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical