Provider Demographics
NPI:1871244723
Name:TOMCZYK, MICHAEL STANLEY (APRN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:STANLEY
Last Name:TOMCZYK
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6312
Mailing Address - Country:US
Mailing Address - Phone:860-582-3235
Mailing Address - Fax:
Practice Address - Street 1:15 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-6312
Practice Address - Country:US
Practice Address - Phone:860-582-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026686363L00000X
CT10333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner