Provider Demographics
NPI:1043738768
Name:NICKLE, SARA CATHLEEN (DNP, FNP-C, APRN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CATHLEEN
Last Name:NICKLE
Suffix:
Gender:F
Credentials:DNP, FNP-C, APRN
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:CATHLEEN
Other - Last Name:REYNLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-C, APRN
Mailing Address - Street 1:244 WARRENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1128
Mailing Address - Country:US
Mailing Address - Phone:860-208-1429
Mailing Address - Fax:
Practice Address - Street 1:330 POMFRET ST
Practice Address - Street 2:
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1854
Practice Address - Country:US
Practice Address - Phone:860-928-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-01
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily