Provider Demographics
NPI:1053631671
Name:BROKOS, CAROLE B (CRNP)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:B
Last Name:BROKOS
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 1:22 S GREENE ST
Mailing Address - Street 2:UNIVERSITY OF MARYLAND MEDICAL CENTER
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-5750
Mailing Address - Fax:410-328-9115
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:UNIVERSITY OF MARYLAND MEDICAL CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5750
Practice Address - Fax:410-328-9115
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR084473363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health