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NPI Code Detail

MEDICARE: MRS. NICOLE EDDY ORTIZ MSN, APRN, FNP-BC

MEDICARE: MRS. NICOLE EDDY ORTIZ MSN, APRN, FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner5728CT

General Provider Information

NPI Number : 1245644954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE EDDY ORTIZ MSN, APRN, FNP-BC
Provider Business Mailing Address
First Line : 326 WASHINGTON ST
Second Line :
City : NORWICH
State : CT
Zip : 06360-2740
Country : US
Telephone Number : 860-889-8331
Fax Number :
Provider Business Practice Location Address
First Line : 80 NORWICH NEW LONDON TPKE
Second Line :
City : UNCASVILLE
State : CT
Zip : 06382-2527
Country : US
Telephone Number : 860-848-1297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2014
Last Update Date : 06/20/2014

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