Provider Demographics
NPI:1134315393
Name:VINICK, CAROL JANE (APRN)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JANE
Last Name:VINICK
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 1:300 WETHERSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06114-1409
Mailing Address - Country:US
Mailing Address - Phone:860-695-1098
Mailing Address - Fax:860-722-6812
Practice Address - Street 1:300 WETHERSFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1409
Practice Address - Country:US
Practice Address - Phone:860-695-1098
Practice Address - Fax:860-722-6812
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily