Provider Demographics
NPI:1407519101
Name:BROCK, JENNIFER (NCPRSS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:NCPRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 COOL SPRINGS BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6574
Mailing Address - Country:US
Mailing Address - Phone:888-339-9404
Mailing Address - Fax:
Practice Address - Street 1:1801 NE 123RD ST STE 314
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2883
Practice Address - Country:US
Practice Address - Phone:888-339-9404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist