Provider Demographics
NPI:1275099608
Name:CONNOLLY, AMY BROOK (FNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BROOK
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 COLTSGATE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3573
Mailing Address - Country:US
Mailing Address - Phone:828-318-3366
Mailing Address - Fax:
Practice Address - Street 1:2700 COLTSGATE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-3799
Practice Address - Country:US
Practice Address - Phone:704-365-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF09181138363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily