Provider Demographics
NPI:1831271675
Name:SCARLATA, KRISTIN (APRN)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:SCARLATA
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 1:17 CASE ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2214
Mailing Address - Country:US
Mailing Address - Phone:860-886-2461
Mailing Address - Fax:860-887-8530
Practice Address - Street 1:17 CASE ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2214
Practice Address - Country:US
Practice Address - Phone:860-886-2461
Practice Address - Fax:860-887-8530
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001760363LX0001X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004207438Medicaid
CTP01450Medicare UPIN
CT500000399Medicare PIN