Provider Demographics
NPI:1164772505
Name:BROOK, KRISTINE D (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:D
Last Name:BROOK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 APPALACHIAN CIR
Mailing Address - Street 2:APT 105
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2744
Mailing Address - Country:US
Mailing Address - Phone:703-865-8848
Mailing Address - Fax:
Practice Address - Street 1:10300 APPALACHIAN CIR
Practice Address - Street 2:APT 105
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2744
Practice Address - Country:US
Practice Address - Phone:703-865-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily