Healthcare Provider Details

I. General information

NPI: 1316705262
Provider Name (Legal Business Name): NICHOLE E CHOUINARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WOODLAND ST FL 5
HARTFORD CT
06105-1208
US

IV. Provider business mailing address

114 WOODLAND ST FL 5
HARTFORD CT
06105-1208
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-6178
  • Fax:
Mailing address:
  • Phone: 860-714-6178
  • Fax: 860-714-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12927
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: