Provider Demographics
NPI:1841816956
Name:ANGELA OLIVIA ROBERTS, APRN, LLC
Entity type:Organization
Organization Name:ANGELA OLIVIA ROBERTS, APRN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:OLIVIA
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:959-207-1951
Mailing Address - Street 1:3021 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3765
Mailing Address - Country:US
Mailing Address - Phone:860-256-9367
Mailing Address - Fax:
Practice Address - Street 1:427 NAUBUC AVE STE 101
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1082
Practice Address - Country:US
Practice Address - Phone:959-207-1951
Practice Address - Fax:888-845-1141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health