Healthcare Provider Details

I. General information

NPI: 1558932269
Provider Name (Legal Business Name): POLINA KOTONI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2021
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 MAIN ST
NASHVILLE TN
37206-3614
US

IV. Provider business mailing address

77 POND AVE APT 411
BROOKLINE MA
02445-7113
US

V. Phone/Fax

Practice location:
  • Phone: 615-436-9060
  • Fax: 615-235-9725
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN270284
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN270284
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: