Provider Demographics
NPI:1215922836
Name:ROBINSON, JOYCE (PA)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 SILAS DEANE HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:860-972-9033
Mailing Address - Fax:860-972-7040
Practice Address - Street 1:163 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415
Practice Address - Country:US
Practice Address - Phone:860-537-4601
Practice Address - Fax:860-537-6935
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1109-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42987600Medicaid
WI0033Medicare PIN
WI001301473Medicare PIN
WI42987600Medicaid