Provider Demographics
NPI:1821667452
Name:POLYCARPE, MIRLENE (FNP, DNP)
Entity Type:Individual
Prefix:MRS
First Name:MIRLENE
Middle Name:
Last Name:POLYCARPE
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 RETREAT AVENUE
Mailing Address - Street 2:HHCMG/CANCER CENTER/HARTFORD HOSPITAL
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2555
Mailing Address - Country:US
Mailing Address - Phone:860-972-4183
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:50 EASTBURY HILL DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-8755
Practice Address - Country:US
Practice Address - Phone:860-834-0479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9761363LF0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program