Provider Demographics
NPI:1669219275
Name:WILLIAMS, CARLA CRISTINA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:CRISTINA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:CRISTINA
Other - Last Name:LOPES MONTEIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3005
Mailing Address - Country:US
Mailing Address - Phone:860-759-6019
Mailing Address - Fax:
Practice Address - Street 1:145 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3005
Practice Address - Country:US
Practice Address - Phone:860-759-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.013437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily