Provider Demographics
NPI:1912171059
Name:PICAGLI, DOREEN ANNE (FNP-BC, APRN)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:ANNE
Last Name:PICAGLI
Suffix:
Gender:F
Credentials:FNP-BC, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 HOWARD AVE
Mailing Address - Street 2:TOMPKINS BUILDING
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1304
Mailing Address - Country:US
Mailing Address - Phone:203-688-8086
Mailing Address - Fax:203-688-1796
Practice Address - Street 1:789 HOWARD AVE
Practice Address - Street 2:TOMPKINS BUILDING
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1304
Practice Address - Country:US
Practice Address - Phone:203-688-8086
Practice Address - Fax:203-688-1796
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily