Provider Demographics
NPI:1437554813
Name:BROCKMAN, DANA M (APRN)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4200
Mailing Address - Fax:615-425-4268
Practice Address - Street 1:102 W JOHN ROWAN BLVD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2663
Practice Address - Country:US
Practice Address - Phone:502-348-7880
Practice Address - Fax:502-348-7881
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYAPRN # - 3008918363LF0000X
KYRN # - 1106829363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily