Provider Demographics
NPI:1689805749
Name:GOVOLA, DIANA VITA (APRN)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:VITA
Last Name:GOVOLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:VITA
Other - Last Name:JIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:400 CAPITAL BLVD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3576
Mailing Address - Country:US
Mailing Address - Phone:860-560-6979
Mailing Address - Fax:860-702-9446
Practice Address - Street 1:400 CAPITAL BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3576
Practice Address - Country:US
Practice Address - Phone:860-560-6979
Practice Address - Fax:860-702-9446
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4143363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health