Healthcare Provider Details

I. General information

NPI: 1073435822
Provider Name (Legal Business Name): NICOLAS BROWN POTENZA BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 CHRISTOPHER LN
MERIDEN CT
06451-5029
US

IV. Provider business mailing address

58 CHRISTOPHER LN
MERIDEN CT
06451-5029
US

V. Phone/Fax

Practice location:
  • Phone: 203-824-8779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number216072
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: