Provider Demographics
NPI:1770626129
Name:MIGNOSA, TRICIA (APRN)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:MIGNOSA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:
Other - Last Name:BELLUCCI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2415 BOSTON POST RD STE 12
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-4348
Mailing Address - Country:US
Mailing Address - Phone:203-693-4566
Mailing Address - Fax:203-457-5970
Practice Address - Street 1:2415 BOSTON POST RD STE 12
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-4348
Practice Address - Country:US
Practice Address - Phone:203-693-4566
Practice Address - Fax:203-457-5970
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063931041C0700X
CT5763363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0040399533Medicaid