Healthcare Provider Details

I. General information

NPI: 1396216289
Provider Name (Legal Business Name): GINA POLLINA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16620 N 40TH ST STE E-1
PHOENIX AZ
85032-3348
US

IV. Provider business mailing address

16430 N SCOTTSDALE RD STE 210
SCOTTSDALE AZ
85254-1581
US

V. Phone/Fax

Practice location:
  • Phone: 602-464-9576
  • Fax: 602-626-8901
Mailing address:
  • Phone: 602-266-8700
  • Fax: 602-626-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number819589
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number274472
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: