Nicole Marilyn Wagschal, MSN APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

005423 Issued in CT

Practice address

3514 Main St
CVS- Minute Clinic
Coventry, CT 06238-1551

Phone

(866) 389-2727

NPI assigned

Jun 28, 2007

Last updated

Oct 29, 2013By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Nicole Marilyn Tubbs Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383004800000",
    "number": "1003013525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 BALAZS RD",
            "city": "WILLINGTON",
            "state": "CT",
            "postal_code": "062792401",
            "telephone_number": "866-389-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3514 MAIN ST",
            "address_2": "CVS- MINUTE CLINIC",
            "city": "COVENTRY",
            "state": "CT",
            "postal_code": "062381551",
            "telephone_number": "866-389-2727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGSCHAL",
        "first_name": "NICOLE",
        "middle_name": "MARILYN",
        "credential": "MSN APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2013-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "005423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "TUBBS",
            "middle_name": "MARILYN",
            "credential": "MSN CRNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Therian, LMFT
• TLC Healthcare Solutions LLC
• Town of Coventry (Town of Coventry Fire/EMS)
• Karen Valrie Vassell
• Erika Visinski, MSN, FNP-C
• Walgreen Co (Walgreens #11919)
• Whole Life Inc.
• Geneva Zetterstrom, FNP-C

• Family Nurse Practitioner in Coventry, CT
• Providers in Coventry, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.