Provider Demographics
NPI:1316070691
Name:BRACCI, BRIAN ANDREW (CS APRN BC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ANDREW
Last Name:BRACCI
Suffix:
Gender:M
Credentials:CS APRN BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:391 SHAKER ROAD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06083
Mailing Address - Country:US
Mailing Address - Phone:860-763-6580
Mailing Address - Fax:860-763-6581
Practice Address - Street 1:391 SHAKER ROAD
Practice Address - Street 2:UNIT 1
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06083
Practice Address - Country:US
Practice Address - Phone:860-763-6580
Practice Address - Fax:860-763-6581
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTR53620163W00000X
CT002663364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MBO78646OOtherDEA