Provider Demographics
NPI:1497031439
Name:BROCK, ANNA LEOVEY (APRN, FNPBC)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:LEOVEY
Last Name:BROCK
Suffix:
Gender:F
Credentials:APRN, FNPBC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIA
Other - Last Name:LEOVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-0793
Mailing Address - Country:US
Mailing Address - Phone:860-808-9748
Mailing Address - Fax:
Practice Address - Street 1:28 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3654
Practice Address - Country:US
Practice Address - Phone:860-358-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily