=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649684036
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE J. PHILLIPS DNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2014
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2091 FAIRFIELD AVE STE 1
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06605-2246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-572-7491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2091 FAIRFIELD AVE
-----------------------------------------------------
City | BRIDGEPORT
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06605-2246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 475-575-2273
-----------------------------------------------------
Fax | 475-575-7244
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5749
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------