Provider Demographics
NPI:1508332651
Name:BROCKMAN, AMANDA CHERYL (NP-C, FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CHERYL
Last Name:BROCKMAN
Suffix:
Gender:F
Credentials:NP-C, FNP-BC
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:C
Other - Last Name:BROCKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4432 VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3977
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4432 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-3977
Practice Address - Country:US
Practice Address - Phone:615-969-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000024726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily