Provider Demographics
NPI:1619686474
Name:MONGILLO, CORINNE SCARLETT (FNP)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:SCARLETT
Last Name:MONGILLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2714
Mailing Address - Country:US
Mailing Address - Phone:860-919-1050
Mailing Address - Fax:
Practice Address - Street 1:677 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2714
Practice Address - Country:US
Practice Address - Phone:860-919-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily