Provider Demographics
NPI:1881096220
Name:SPADACCINI, LINDA (FNP-BC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SPADACCINI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 WILLARD AVE
Mailing Address - Street 2:STE 2D
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-2316
Mailing Address - Country:US
Mailing Address - Phone:860-528-2138
Mailing Address - Fax:860-528-0514
Practice Address - Street 1:365 WILLARD AVE
Practice Address - Street 2:STE 2D
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2316
Practice Address - Country:US
Practice Address - Phone:860-528-2138
Practice Address - Fax:860-528-0514
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT005717OtherLICENSE #