Provider Demographics
NPI:1407595325
Name:COBB, BROOKE HINTON (DNP, FNP)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:HINTON
Last Name:COBB
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 PAUL COBB RD
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:GA
Mailing Address - Zip Code:30413-2904
Mailing Address - Country:US
Mailing Address - Phone:478-232-4346
Mailing Address - Fax:
Practice Address - Street 1:610 FERNCREST DR STE A
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1863
Practice Address - Country:US
Practice Address - Phone:478-552-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN268394OtherGEORGIA NURSING BOARD