Provider Demographics
NPI:1043785744
Name:CALDWELL, BROOKE MARRON (MSN, RN, AGNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MARRON
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MSN, RN, AGNP-C
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:MARRON
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:10260 N CENTRAL EXPY # 100N
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3437
Mailing Address - Country:US
Mailing Address - Phone:214-363-5535
Mailing Address - Fax:
Practice Address - Street 1:10260 N CENTRAL EXPY # 100N
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3437
Practice Address - Country:US
Practice Address - Phone:214-363-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138729363LP0808X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology