Provider Demographics
NPI:1689627044
Name:FRICK, PHILIP (DNP, APRN)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:FRICK
Suffix:
Gender:M
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-0719
Mailing Address - Country:US
Mailing Address - Phone:860-961-0785
Mailing Address - Fax:203-891-5976
Practice Address - Street 1:30 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512
Practice Address - Country:US
Practice Address - Phone:860-961-0785
Practice Address - Fax:203-891-5976
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2715363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008013924Medicaid
CTP66344Medicare UPIN