Provider Demographics
NPI:1851631683
Name:WILLIAMS, TIA JEAN (PA-C, MMSC)
Entity type:Individual
Prefix:
First Name:TIA
Middle Name:JEAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C, MMSC
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:JEAN
Other - Last Name:FERRAROTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MMSC
Mailing Address - Street 1:538 LITCHFIELD ST STE G01
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6669
Mailing Address - Country:US
Mailing Address - Phone:860-496-9877
Mailing Address - Fax:860-496-0441
Practice Address - Street 1:1111 CROMWELL AVE # 404
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067
Practice Address - Country:US
Practice Address - Phone:860-525-4469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X, 363AS0400X
CT002877363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical