Individual
MRS. TINA KATSARIKAS MCGILLICUDDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN NURSE PRACTITIO
Contact information
Practice address
400 COLUMBUS AVE, NEW HAVEN, CT 06519-1233
(203) 503-3250
(203) 503-3254
Mailing address
400 COLUMBUS AVE, NEW HAVEN, CT 06519-1233
(203) 503-3250
(203) 503-3254
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
151957
TN
163W00000X
Registered Nurse
079084
CT
363LP0200X
Pediatric Nurse Practitioner
Primary
003531
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235900
—
CT
Enumeration date
03/13/2007
Last updated
12/12/2011
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