Healthcare Provider Details

I. General information

NPI: 1871244723
Provider Name (Legal Business Name): MICHAEL STANLEY TOMCZYK APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 RIVERSIDE AVE
BRISTOL CT
06010-6312
US

IV. Provider business mailing address

15 RIVERSIDE AVE
BRISTOL CT
06010-6312
US

V. Phone/Fax

Practice location:
  • Phone: 860-582-3235
  • Fax:
Mailing address:
  • Phone: 860-582-3235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10333
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11026686
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: