MS. TRACY G CIVITILLO (NPI# 1639235609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639235609 |
| Entity Type | Individual |
| Full Name | MS. TRACY G CIVITILLO |
| Credential | MHS, PA-C |
| Practice Address |
500 Blue Hills Ave Hartford CT 06112-1500 |
| Mailing Address |
71 Hickory Hill Rd Simsbury CT 06070-2832 |
| Practice Telephone | 8607144000 |
| Mailing Telephone | 8603062087 |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2010-09-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
000974 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CT | MEDICARE | C03656 | 01 |
| Street Address |
500 BLUE HILLS AVE |
| City | HARTFORD |
| State | CT |
| Zip Code | 06112-1500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336199736 | Narasimhan Chandra Narayanan | Surgery | 500 Blue Hills Ave, Wound Care Center, Hartford, CT 06112-1500 | 2006-05-10 |
| 1437612116 | Burton E Callahan IIi | Counselor | 500 Blue Hills Ave, Hartford, CT 06112-1500 | 2019-04-10 |
| 1609338938 | Aneta J Godlewski | Counselor | 500 Blue Hills Ave, Hartford, CT 06112-1500 | 2019-04-04 |
| 1689061277 | Rose-marie Marotta-graves | Social Worker | 500 Blue Hills Ave, Hartford, CT 06112-1500 | 2015-04-21 |
| 1801162664 | Michael C Zito Jr. | Counselor | 500 Blue Hills Ave, 6th Floor, Hartford, CT 06112-1500 | 2012-03-27 |
| 1588959068 | Alberto Luis Gonzalez | Psychologist | 500 Blue Hills Ave, Hartford, CT 06112-1500 | 2011-06-13 |
| 1972769776 | Ernest Jermin II | Psychiatry & Neurology | 500 Blue Hills Ave, Hartford, CT 06112-1500 | 2008-07-31 |
| 1982866141 | Darlene A Saucier | Nurse Practitioner | 500 Blue Hills Ave, Wound Care Center, Hartford, CT 06112-1500 | 2008-06-30 |
| 1740499656 | Tracey Edan Krasnow | Pediatrics | 500 Blue Hills Ave, Hartford, CT 06112-1500 | 2007-05-21 |
| 1891901393 | Saint Francis Hospital and Medical Center | General Acute Care Hospital | 500 Blue Hills Ave, Suite 406, Hartford, CT 06112-1500 | 2007-05-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841810355 | Ashwin Mahesh | Student in an Organized Health Care Education/Training Program | 131 Coventry Street, 2nd Floor, Burgdorf Clinic, Hartford, CT 06112 | 2020-04-24 |
| 1336600527 | Waleed Ibrahim | Student in an Organized Health Care Education/Training Program | Burgdorf Clinic, 131 Coventry Street 2nd Floor, Hartford, CT 06112 | 2019-03-29 |
| 1740741941 | Hajra Munawar | Student in an Organized Health Care Education/Training Program | Burgdorf Clinic 131 Coventry Street, Hartford, CT 06112 | 2019-03-29 |
| 1194191973 | Esther Wint | Nurse Practitioner | 490 Blue Ave, Hartford, CT 06112 | 2015-08-17 |
| 1194105700 | Michelle Russi | Physical Therapy Assistant | 490 Blue Hill Ave., Hartford, CT 06112 | 2015-06-09 |
| 1366858359 | Krysten N Marotta | Pharmacist | 1290 Albany Ave, Hartford, CT 06112 | 2014-07-10 |
| 1447403522 | Moon Hee Yoo | Psychiatry & Neurology | 500 Vine St., Capitol Region Mental Health Center, Hartford, CT 06112 | 2008-11-03 |
| 1992958094 | Roxann Marie Ellis-denby | Social Worker | 51 Coventry Street, Capitol Region Mental Health Center, Hartford, CT 06112 | 2008-11-03 |
| 1265590871 | The Connecticut Institute for The Blind | Intermediate Care Facility, Mentally Retarded | 120 Holcomb Street, Hartford, CT 06112 | 2006-12-05 |
| 1164580379 | Intercommunity, Inc. | Clinic/Center | 16 Coventry Street, Hartford, CT 06112 | 2006-12-04 |
| Find all providers in zip 06112 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275192049 | Molly J Mable | Physician Assistant | 282 Washington St Fl 1, Hartford, CT 06106-3322 | 2019-06-06 |
| 1952821431 | Andrew J Decusati | Physician Assistant | 100 Retreat Ave Ste 705, Hartford, CT 06106-2553 | 2017-06-26 |
| 1427466150 | Katherine Salvador | Physician Assistant | 14 Weston St, Hartford, CT 06120-1504 | 2014-07-25 |
| 1336130459 | Michael Peter Terp | Physician Assistant | 1000 Asylum Ave Ste 2109a, Saint Francis Emergency Medical Group Inc, Hartford, CT 06105-1719 | 2005-10-31 |
| 1043834856 | Carly Lavallee | Physician Assistant | 80 Seymour St, Hartford, CT 06106-3315 | 2020-06-08 |
| 1316561251 | Amelia Kay Schuler | Physician Assistant | 80 Seymour St, Hartford, CT 06106-3300 | 2020-06-06 |
| 1962026229 | Rashadda E Wong | Physician Assistant | 80 Seymour St, Hartford, CT 06106-3315 | 2020-06-02 |
| 1629691043 | Kara Martin | Physician Assistant | 80 Seymour St, Hartford, CT 06102-8000 | 2020-05-20 |
| 1336761626 | Allison Leigh Verity | Physician Assistant | 80 Seymour St, Hartford, CT 06102-8000 | 2020-05-11 |
| 1326677352 | Brittany Michelle Wozniak | Physician Assistant | 80 Seymour St, Hartford, CT 06102-8000 | 2020-04-02 |
| Find all providers in HARTFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.