Provider Demographics
NPI:1245929546
Name:GOLLIE, TORI (CRNP)
Entity type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:GOLLIE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-9642
Mailing Address - Country:US
Mailing Address - Phone:610-730-1296
Mailing Address - Fax:
Practice Address - Street 1:3080 HAMILTON BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3694
Practice Address - Country:US
Practice Address - Phone:610-402-5988
Practice Address - Fax:610-402-5989
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily