Provider Demographics
NPI:1972323293
Name:BIGDELIAZARI, NICHOLE (APRN)
Entity type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:
Last Name:BIGDELIAZARI
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 1:1717 HIGHCROFT PL
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-7923
Mailing Address - Country:US
Mailing Address - Phone:508-395-3918
Mailing Address - Fax:
Practice Address - Street 1:1 DARLING DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4277
Practice Address - Country:US
Practice Address - Phone:860-404-2137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.014003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily