Provider Demographics
NPI:1588762116
Name:ROSATO, CARLA M (FNP)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:M
Last Name:ROSATO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:M
Other - Last Name:GENEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:15 NANCY MAE AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1720
Mailing Address - Country:US
Mailing Address - Phone:203-528-7652
Mailing Address - Fax:
Practice Address - Street 1:15 NANCY MAE AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:CT
Practice Address - Zip Code:06712-1720
Practice Address - Country:US
Practice Address - Phone:203-528-7652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTRN1947012363LF0000X
CT003524363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003524OtherSTATE LICENSE
CT004235900Medicaid
CTMR1495856OtherDEA