Healthcare Provider Details

I. General information

NPI: 1275358715
Provider Name (Legal Business Name): NICOLE ANNA MONTOYA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 02/15/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 RIVER ST
SPRINGFIELD VT
05156-2930
US

IV. Provider business mailing address

11 LINDEN AVE
NEWPORT NH
03773-1471
US

V. Phone/Fax

Practice location:
  • Phone: 802-886-8900
  • Fax:
Mailing address:
  • Phone: 904-631-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number101.0137946
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11035705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: