Provider Demographics
NPI:1811602303
Name:AUSTIN, GINA MARIE (AGACNP)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:AUSTIN
Suffix:
Gender:
Credentials:AGACNP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:VAGNINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGACNP
Mailing Address - Street 1:113 W DISTRICT RD
Mailing Address - Street 2:
Mailing Address - City:UNIONVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06085-1463
Mailing Address - Country:US
Mailing Address - Phone:860-849-6112
Mailing Address - Fax:
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-3300
Practice Address - Country:US
Practice Address - Phone:860-545-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13742363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care