Provider Demographics
NPI:1124329461
Name:SMOLKA, HEIDI MARIE (APRN)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:MARIE
Last Name:SMOLKA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:2110 SILAS DEANE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2313
Mailing Address - Country:US
Mailing Address - Phone:860-258-3470
Mailing Address - Fax:860-571-6800
Practice Address - Street 1:100 RETREAT AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2528
Practice Address - Country:US
Practice Address - Phone:860-547-1278
Practice Address - Fax:860-547-1301
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT004529363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400055972Medicare PIN