Healthcare Provider Details

I. General information

NPI: 1144972746
Provider Name (Legal Business Name): NEST COLLABORATIVE OF TEXAS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HATTERS LN
FARMINGTON CT
06032-2332
US

IV. Provider business mailing address

8 HATTERS LN
FARMINGTON CT
06032-2332
US

V. Phone/Fax

Practice location:
  • Phone: 917-567-5260
  • Fax: 844-364-2618
Mailing address:
  • Phone: 917-567-5260
  • Fax: 844-364-2618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name: AMANDA GORMAN
Title or Position: FOUNDER
Credential: CRNP
Phone: 917-567-5260