Provider Demographics
NPI:1851585905
Name:HRICIK, ELIZABETH SUSAN (PA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:HRICIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SUSAN
Other - Last Name:HRICIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:11 MOORLAND RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-3823
Mailing Address - Country:US
Mailing Address - Phone:203-650-2258
Mailing Address - Fax:
Practice Address - Street 1:11 MOORLAND RD
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-3823
Practice Address - Country:US
Practice Address - Phone:203-650-2258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000491363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant