Provider Demographics
NPI:1639430168
Name:GORMLY, CHRISTINA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:GORMLY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TARA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-2809
Mailing Address - Country:US
Mailing Address - Phone:603-460-5504
Mailing Address - Fax:603-546-4012
Practice Address - Street 1:1 TARA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-2809
Practice Address - Country:US
Practice Address - Phone:603-460-5504
Practice Address - Fax:603-546-4012
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH09321223363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health