Provider Demographics
NPI:1467709097
Name:MURPHY, ANDREA DIAS (APRN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DIAS
Last Name:MURPHY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MARIE
Other - Last Name:DIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:772 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-1142
Mailing Address - Country:US
Mailing Address - Phone:508-951-7183
Mailing Address - Fax:
Practice Address - Street 1:1741 ELLINGTON RD
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2720
Practice Address - Country:US
Practice Address - Phone:860-263-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005071363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004050712Medicaid
CT004050712Medicaid
CTD400080182 - C00814Medicare PIN