Healthcare Provider Details

I. General information

NPI: 1972323293
Provider Name (Legal Business Name): NICHOLE BIGDELIAZARI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DARLING DR
AVON CT
06001-4277
US

IV. Provider business mailing address

1717 HIGHCROFT PL
WEATOGUE CT
06089-7923
US

V. Phone/Fax

Practice location:
  • Phone: 860-404-2137
  • Fax:
Mailing address:
  • Phone: 508-395-3918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12.014003
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: