Provider Demographics
NPI:1447847348
Name:TWICKLER, ADAM (AGNP-C, APRN)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:TWICKLER
Suffix:
Gender:M
Credentials:AGNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 E RIVER DR FL 5
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:758-826-8244
Mailing Address - Fax:
Practice Address - Street 1:240 INDIAN RIVER RD STE A8
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3690
Practice Address - Country:US
Practice Address - Phone:475-882-6824
Practice Address - Fax:860-289-0746
Is Sole Proprietor?:No
Enumeration Date:2020-12-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9352363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health