Provider Demographics
NPI:1144972746
Name:NEST COLLABORATIVE OF TEXAS, PLLC
Entity type:Organization
Organization Name:NEST COLLABORATIVE OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:917-567-5260
Mailing Address - Street 1:8 HATTERS LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2332
Mailing Address - Country:US
Mailing Address - Phone:917-567-5260
Mailing Address - Fax:844-364-2618
Practice Address - Street 1:8 HATTERS LN
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2332
Practice Address - Country:US
Practice Address - Phone:917-567-5260
Practice Address - Fax:844-364-2618
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEST COLLABORATIVE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty