Provider Demographics
NPI:1609362847
Name:RIZZA, NANCY ELAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ELAINE
Last Name:RIZZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 SULLIVAN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2711
Mailing Address - Country:US
Mailing Address - Phone:860-432-8400
Mailing Address - Fax:860-432-8430
Practice Address - Street 1:1504 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2711
Practice Address - Country:US
Practice Address - Phone:860-432-8400
Practice Address - Fax:860-432-8430
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty