Provider Demographics
NPI:1174685986
Name:TOBIN, NICHOLAS (CNP, PCNS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:TOBIN
Suffix:
Gender:M
Credentials:CNP, PCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 DWIGHT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1767
Mailing Address - Country:US
Mailing Address - Phone:413-266-8326
Mailing Address - Fax:413-317-7218
Practice Address - Street 1:175 DWIGHT RD STE 103
Practice Address - Street 2:
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1767
Practice Address - Country:US
Practice Address - Phone:413-266-8326
Practice Address - Fax:413-317-7218
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003515363L00000X
MARN252000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner