Individual
MS. TRACY G CIVITILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS, PA-C
Contact information
Practice address
500 BLUE HILLS AVE, HARTFORD, CT 06112-1500
(860) 714-4000
Mailing address
71 HICKORY HILL RD, SIMSBURY, CT 06070-2832
(860) 306-2087
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
000974
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C03656
MEDICARE
CT
Enumeration date
12/27/2006
Last updated
09/17/2010
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