Healthcare Provider Details

I. General information

NPI: 1457041097
Provider Name (Legal Business Name): NENCY ANTOINE DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 COTTAGE GROVE RD STE 107
BLOOMFIELD CT
06002-3088
US

IV. Provider business mailing address

95 WOODLAND ST FL 1
HARTFORD CT
06105-1230
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-8709
  • Fax: 860-243-8259
Mailing address:
  • Phone: 860-714-7470
  • Fax: 860-714-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.465400
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12655
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: