Healthcare Provider Details

I. General information

NPI: 1184557027
Provider Name (Legal Business Name): GINA M SMITH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 GAYLORD FARM RD
WALLINGFORD CT
06492-2899
US

IV. Provider business mailing address

PO BOX 400
WALLINGFORD CT
06492-7048
US

V. Phone/Fax

Practice location:
  • Phone: 203-284-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number12.017584
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: