Basic Information
| Provider Information | |||||||||
| NPI: | 1649382797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COSTANZA | ||||||||
| FirstName: | CHRISTY | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 332 SUMNER HALL DR | ||||||||
| Address2: | |||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370663129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154604500 | ||||||||
| FaxNumber: | 6154604502 | ||||||||
| Practice Location | |||||||||
| Address1: | 332 SUMNER HALL DR | ||||||||
| Address2: | |||||||||
| City: | GALLATIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370663129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154604500 | ||||||||
| FaxNumber: | 6154604502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 03/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 17522 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.