Provider Demographics
NPI:1659611978
Name:RICAFORT, MELANIE DULCE (APRN)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:DULCE
Last Name:RICAFORT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3060
Mailing Address - Country:US
Mailing Address - Phone:860-242-8756
Mailing Address - Fax:860-242-3052
Practice Address - Street 1:711 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3060
Practice Address - Country:US
Practice Address - Phone:860-242-8756
Practice Address - Fax:860-242-3052
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00530363LA2100X, 363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008043707Medicaid
CT075726OtherCONNECTICARE
CTD400085911OtherMEDICARE
CTD400085911OtherMEDICARE
CTMDULCE410Medicare UPIN
CTMDULCE410Medicare PIN