Individual
NICOLE GRILLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1000 ASYLUM AVE, SUITE 3207, HARTFORD, CT 06105-1770
(860) 714-5416
(860) 714-8860
Mailing address
1000 ASYLUM AVE, SUITE 3207, HARTFORD, CT 06105-1770
(860) 714-5416
(860) 714-8860
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001031
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
290001031CT01
ANTHEM BLUE SHIELD
CT
01
—
2V2435
HEALTHNET
—
Enumeration date
07/23/2006
Last updated
07/08/2007
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