Provider Demographics
NPI:1285471607
Name:SURINA, MIKAYLA COLLEEN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:COLLEEN
Last Name:SURINA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:COLLEEN
Other - Last Name:FAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:45 TURKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4424
Mailing Address - Country:US
Mailing Address - Phone:845-637-0952
Mailing Address - Fax:
Practice Address - Street 1:950 YALE AVE STE 39
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1884
Practice Address - Country:US
Practice Address - Phone:203-265-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily