Provider Demographics
NPI:1407367212
Name:STRAND, NICOLE POTUCEK (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:POTUCEK
Last Name:STRAND
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 INDIAN RIVER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3627
Mailing Address - Country:US
Mailing Address - Phone:203-865-6143
Mailing Address - Fax:203-772-1265
Practice Address - Street 1:250 INDIAN RIVER RD STE 300
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3627
Practice Address - Country:US
Practice Address - Phone:203-865-6143
Practice Address - Fax:203-772-1265
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily