Basic Information
Provider Information | |||||||||
NPI: | 1821283961 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ABBATE | ||||||||
FirstName: | DARLENE | ||||||||
MiddleName: | FLORENCE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | ABBATE | ||||||||
OtherFirstName: | DARLENE | ||||||||
OtherMiddleName: | FLORENCE | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | APRN | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | 35 RUDNANSKY LN | ||||||||
Address2: |   | ||||||||
City: | TOLLAND | ||||||||
State: | CT | ||||||||
PostalCode: | 060842291 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8608717639 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 76 NEW BRITAIN AVE | ||||||||
Address2: |   | ||||||||
City: | HARTFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 061063305 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8605459300 | ||||||||
FaxNumber: | 8608376801 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/12/2007 | ||||||||
LastUpdateDate: | 04/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 001578 | CT | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
ID | Type | State | Issuer | Description | 1821283961 | 05 | CT |   | MEDICAID |