Provider Demographics
NPI:1801366646
Name:NAGLE, KERIN ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:KERIN
Middle Name:ELIZABETH
Last Name:NAGLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KERIN
Other - Middle Name:ELIZABETH
Other - Last Name:GILLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120
Mailing Address - Country:US
Mailing Address - Phone:860-462-6764
Mailing Address - Fax:
Practice Address - Street 1:COMMUNITY HEALTH SERVICES
Practice Address - Street 2:500 ALBANY AVE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2508
Practice Address - Country:US
Practice Address - Phone:860-249-9625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTF09181069363LF0000X
CT007963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily