Provider Demographics
NPI:1396093993
Name:VINCA, LINDITA (APRN)
Entity type:Individual
Prefix:
First Name:LINDITA
Middle Name:
Last Name:VINCA
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 1:1781 HIGHLAND AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1254
Mailing Address - Country:US
Mailing Address - Phone:203-694-5857
Mailing Address - Fax:860-694-5616
Practice Address - Street 1:1781 HIGHLAND AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1254
Practice Address - Country:US
Practice Address - Phone:203-694-5857
Practice Address - Fax:203-694-5616
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5085363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner