Healthcare Provider Details

I. General information

NPI: 1770378770
Provider Name (Legal Business Name): NICA F CHUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 BLOOMFIELD AVE
BLOOMFIELD CT
06002-2489
US

IV. Provider business mailing address

2 WATERSIDE XING STE 401
WINDSOR CT
06095-1588
US

V. Phone/Fax

Practice location:
  • Phone: 860-731-5522
  • Fax: 890-731-5536
Mailing address:
  • Phone: 860-697-3351
  • Fax: 860-731-5536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number018085
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: