Healthcare Provider Details

I. General information

NPI: 1871489864
Provider Name (Legal Business Name): KRISTEN TOOMA MSN, APRN, AGNCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SMITH HAVEN MALL STE 110
LAKE GROVE NY
11755-1219
US

IV. Provider business mailing address

24 RESEARCH WAY STE 500
EAST SETAUKET NY
11733-3470
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-6270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number311343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: