Provider Demographics
NPI:1326164393
Name:BROCK, BARBARA ACKER (FNP,MSN,IBCLC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ACKER
Last Name:BROCK
Suffix:
Gender:F
Credentials:FNP,MSN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 INDUSTRIAL PARK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-4701
Mailing Address - Country:US
Mailing Address - Phone:865-397-3930
Mailing Address - Fax:
Practice Address - Street 1:931 INDUSTRIAL PARK RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-4701
Practice Address - Country:US
Practice Address - Phone:865-397-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN005548363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNS87168Medicare UPIN