Provider Demographics
NPI:1679765275
Name:CORTES, CONCEPCION (APRN)
Entity type:Individual
Prefix:
First Name:CONCEPCION
Middle Name:
Last Name:CORTES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 CORBIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-2266
Mailing Address - Country:US
Mailing Address - Phone:860-612-6381
Mailing Address - Fax:860-612-6385
Practice Address - Street 1:2150 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-2266
Practice Address - Country:US
Practice Address - Phone:860-612-6381
Practice Address - Fax:860-612-6385
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003611363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003611OtherADVANCED PRACTICE REGISTERED NURSE LICENSE
CT004036117Medicaid
CT004036117Medicaid
CTD400080139 - C00814Medicare PIN