Provider Demographics
NPI:1114274883
Name:THOMAS, BROOKE M (CNP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 FOXBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4343
Mailing Address - Country:US
Mailing Address - Phone:440-666-0268
Mailing Address - Fax:
Practice Address - Street 1:880 MULL AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-7522
Practice Address - Country:US
Practice Address - Phone:330-590-0847
Practice Address - Fax:330-451-5782
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN362959163W00000X
OHAPRN.CNP.0029939363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse