Provider Demographics
NPI:1205409463
Name:NP PRIMARY CARE PRACTICE, PLLC
Entity Type:Organization
Organization Name:NP PRIMARY CARE PRACTICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, FNP-C
Authorized Official - Phone:203-572-7491
Mailing Address - Street 1:2091 FAIRFIELD AVENUE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-2246
Mailing Address - Country:US
Mailing Address - Phone:203-572-7491
Mailing Address - Fax:
Practice Address - Street 1:2091 FAIRFIELD AVENUE
Practice Address - Street 2:SUITE #1
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-2246
Practice Address - Country:US
Practice Address - Phone:203-572-7491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care