Provider Demographics
NPI:1386066470
Name:IRIMIA, AMBER (APRN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:IRIMIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HALL BLVD
Mailing Address - Street 2:3RD FLOOR, POD D
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2918
Mailing Address - Country:US
Mailing Address - Phone:860-714-2338
Mailing Address - Fax:860-714-8612
Practice Address - Street 1:675 TOWER AVE STE 301
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-714-2750
Practice Address - Fax:860-714-8591
Is Sole Proprietor?:No
Enumeration Date:2014-01-09
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005602363L00000X
CT5602363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner