Provider Demographics
NPI:1134677040
Name:CHOMICK, NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CHOMICK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 JEFFERSON ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2601
Mailing Address - Country:US
Mailing Address - Phone:860-972-1212
Mailing Address - Fax:860-545-3269
Practice Address - Street 1:85 JEFFERSON ST
Practice Address - Street 2:SUITE 208
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2601
Practice Address - Country:US
Practice Address - Phone:860-972-1212
Practice Address - Fax:860-545-3269
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6736363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily