Provider Demographics
NPI:1508366873
Name:BORON, BROOKE ASHLEY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:ASHLEY
Last Name:BORON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 E COOKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2816
Mailing Address - Country:US
Mailing Address - Phone:614-400-3247
Mailing Address - Fax:
Practice Address - Street 1:2269 CHERRY VALLEY RD SE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9323
Practice Address - Country:US
Practice Address - Phone:740-788-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily