Provider Demographics
NPI:1265721963
Name:SAMUELS, PATRICIA A (APRN)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:893 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-2292
Mailing Address - Country:US
Mailing Address - Phone:860-528-2138
Mailing Address - Fax:860-528-0514
Practice Address - Street 1:893 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2293
Practice Address - Country:US
Practice Address - Phone:860-528-2138
Practice Address - Fax:860-528-0514
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4603363L00000X
CT004603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner