Provider Demographics
NPI:1912194796
Name:MENDEZ, ANTHEA (APRN)
Entity Type:Individual
Prefix:
First Name:ANTHEA
Middle Name:
Last Name:MENDEZ
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 1:1177 SILAS DEANE HWY STE 2
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4332
Mailing Address - Country:US
Mailing Address - Phone:860-937-5708
Mailing Address - Fax:860-937-5712
Practice Address - Street 1:1177 SILAS DEANE HWY STE 2
Practice Address - Street 2:
Practice Address - City:WETHERSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06109-4332
Practice Address - Country:US
Practice Address - Phone:860-500-7143
Practice Address - Fax:860-937-5712
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003678363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003678OtherLICENSE
CT42031OtherCT CONTROLLED SUBSTANCE