Anna Liza Abastillas, APRN
Individual provider Active NPI Family Nurse Practitioner · Southington, CT
NPI 1063572014 · NPPES record last updated Feb 1, 2021
Key facts
- NPI
- 1063572014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 002935 (CT)
- Practice address
- 360 14 N Main St
Southington, CT 06489 - Phone
- (860) 621-6759
- Fax
- (860) 621-0117
- NPI assigned
- Dec 11, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250904003638 | CT | Order and Referring Only - Nurse Practitioner | 6406845924 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2935 | CT | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 002935 | CT | |
| Family Nurse Practitioner | 363LF0000X | 002935 | CT | Yes |
Addresses
Primary practice location
360 14 N Main St
Southington, CT 06489
Mailing address
9900 Bren Rd E
Minnetonka, MN 55343-9664
Phone (605) 188-8008
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004241030 | Medicaid | CT |
Other providers in Southington, CT
- A Moment Away LLC
- Jessica Isabel Abrantes-Figueiredo
- Absolute Home Care of CT
- Accu Vision Center, Inc
- Bridgitte F. Ackeifi
- Kasey Adinolfi
All providers in Southington, CT · Family Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.