Diane Packard Annibalini, PA-C
Individual provider Active NPI Physician Assistant · Tolland, CT
NPI 1184956690 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1184956690
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2348 (CT)
- Practice address
- 384 Merrow Rd Ste K
Tolland, CT 06084-3970 - Phone
- (860) 871-8851
- Fax
- (860) 871-8852
- NPI assigned
- Feb 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002348 | CT | MD | Professional Counselor |
| 2348 | CT | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 002348 | CT | |
| Physician Assistant | 363A00000X | 2348 | CT | Yes |
Addresses
Primary practice location
384 Merrow Rd Ste K
Tolland, CT 06084-3970
Mailing address
O6 Saint Marc Cir
South Windsor, CT 06074-4141
Phone (860) 682-3950
Other practice location 1
100 Hazard Ave
Suite 101
Enfield, CT 06082-5446
Phone (860) 696-2380
Other practice location 2
100 Hazard Ave
Suite 101
Enfield, CT 06082-5446
Phone (860) 696-2380
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002348 | Other | CT | CT LICENSE NUMBER |
Other providers in Tolland, CT
- Ace Transportation LLC
- Advanced Orthopedics New England
- Alby Sam LLC
- Dakota Sean Aldrich
- Jennifer Marie Allen
- Sue Armstrong
- Nancy Arnold
- Sarah Assenso-Bediako
- Lisa Jane Backus
- Laura Badecker
All providers in Tolland, CT · Physician Assistant in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.