Provider Demographics
NPI:1477517126
Name:BROCKERT, ANN M (CNP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:BROCKERT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E MARKET ST
Mailing Address - Street 2:ANNEX 3
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:330-375-7512
Mailing Address - Fax:330-375-3445
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:ANNEX 3
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-7512
Practice Address - Fax:330-375-3445
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP03000363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2145354Medicaid
OHPRNP12611Medicare ID - Type Unspecified
OH2145354Medicaid