Provider Demographics
NPI:1134948573
Name:CREGAN, NICOLE MARIE (FNP)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:CREGAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12188-2536
Mailing Address - Country:US
Mailing Address - Phone:516-330-2689
Mailing Address - Fax:
Practice Address - Street 1:47 1ST ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:NY
Practice Address - Zip Code:12188-2536
Practice Address - Country:US
Practice Address - Phone:516-330-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF355187-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily