GINA F LIDESTRI (NPI# 1043403868) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043403868 |
| Entity Type | Individual |
| Full Name | GINA F LIDESTRI |
| Other Name | GINA F MANGARI |
| Credential | PA |
| Practice Address |
41 Brewster Rd Bristol CT 06010-5161 |
| Practice Telephone | 8605853313 |
| Mailing Telephone | 8605853313 |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2012-01-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | 001942 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
001942 | CT | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
41 BREWSTER RD |
| City | BRISTOL |
| State | CT |
| Zip Code | 06010-5161 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922004977 | Kara A Lynch | Physician Assistant | 41 Brewster Rd, Bristol, CT 06010-5161 | 2005-06-23 |
| 1881294486 | Gretchen Holloway | Nurse Practitioner | 41 Brewster Rd, Bristol, CT 06010-5141 | 2020-11-01 |
| 1275133969 | Bristol Health Pharmacy, LLC | Pharmacy | 41 Brewster Rd, Bristol, CT 06010-5161 | 2020-10-30 |
| 1992311195 | Davina Dube | Family Medicine | 41 Brewster Rd, Bristol, CT 06010-5141 | 2020-09-22 |
| 1215549142 | Danielle Sarah Desmarais | Physician Assistant | 41 Brewster Rd, Bristol, CT 06010-5161 | 2020-08-21 |
| 1770192726 | Elina Tannenbaum | Registered Nurse | 41 Brewster Rd, Bristol, CT 06010-5161 | 2020-07-27 |
| 1093331670 | Kendra Jade Mcgregor | Physician Assistant | 41 Brewster Rd, Bristol, CT 06010-5141 | 2020-06-19 |
| 1043832066 | Michael Owen Richards | Internal Medicine | 41 Brewster Rd, Bristol, CT 06010-5161 | 2020-05-13 |
| 1093354953 | Erica Stolarz | Physician Assistant | 41 Brewster Rd, Bristol, CT 06010-5141 | 2019-12-24 |
| 1336703511 | Rachel Driscoll | Dietitian, Registered | 41 Brewster Rd, Bristol, CT 06010-5161 | 2019-04-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457991309 | A New Hope Caregiving Alliance LLC | Home Health | 225 North Main Street - Suite 107, Bristol, CT 06010 | 2020-01-08 |
| 1154981777 | Georgianna Sloate Lmft, LLC | Marriage & Family Therapist | 38 Kelley Street, Bristol, CT 06010 | 2019-06-17 |
| 1962062810 | Ariel Morley | Urology | 15 Riverside Avenue, Bristol, CT 06010 | 2019-06-13 |
| 1013439488 | Theresa Rose Manolitsis | Student in an Organized Health Care Education/Training Program | 170 Pondview Lane, Bristol, CT 06010 | 2017-07-07 |
| 1588103600 | Elizabeth Anne Costello | Pharmacist | 747 Pine Street, Bristol, CT 06010 | 2017-02-22 |
| 1992157903 | Aiman Riaz | Internal Medicine | 41 Brewster Rd # 5161, Bristol, CT 06010 | 2016-07-01 |
| 1346609955 | Monika Magdalena Sullivan | Nurse Practitioner | 122 Maple Street, Bristol, CT 06010 | 2016-02-11 |
| 1346660776 | Peter Bellezza | Podiatrist | 15 Riverside Ave, Bristol, CT 06010 | 2014-04-24 |
| 1487088001 | Stephen Alexander Merwin | Social Worker | 32 Laird Drive, Bristol, CT 06010 | 2013-08-30 |
| 1215369574 | In Kyung Lee | Dentist | 1192 Farmington Ave., Bristol, CT 06010 | 2013-08-08 |
| Find all providers in zip 06010 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487724936 | Mark Steven Mehlferber | Physician Assistant | 320 Bristol West Blvd Ste 2b, Bristol, TN 37620-8765 | 2006-11-09 |
| 1124051750 | Antonio Santoro | Physician Assistant | Bristol Hospital, Brewster Rd., Bristol, CT 06011-0977 | 2006-07-08 |
| 1457353005 | Mark Tabaka | Physician Assistant | 576 Farmington Ave, Bristol, CT 06010-3933 | 2005-08-12 |
| 1497265573 | Brianna Galligan | Physician Assistant | 501 Bath Rd, Bristol, PA 19007-3101 | 2017-10-03 |
| 1578087375 | Hilda M Boateng | Physician Assistant | 41 Brewster Rd, Bristol, CT 06010-5161 | 2017-08-02 |
| 1669822532 | Kristin Somerville | Physician Assistant | 22 Pine St, Bristol, CT 06010-6948 | 2016-06-21 |
| 1467801605 | Kayla Nicole Kennedy | Physician Assistant | 22 Pine St, Suite 104, Bristol, CT 06010-6948 | 2016-06-08 |
| 1447604954 | Carys Roberts | Physician Assistant | 501 Bath Rd, Bristol, PA 19007-3101 | 2016-04-20 |
| 1437565553 | Daniel P Tuohey | Physician Assistant | 539 Farmington Ave, Bristol, CT 06010-3931 | 2014-07-09 |
| 1427486380 | Jaret Williams | Physician Assistant | 539 Farmington Ave, Bristol, CT 06010-3931 | 2013-10-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.