Provider Demographics
NPI:1578032306
Name:BROCK, ADRIENNE LYNN (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:LYNN
Last Name:BROCK
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17201 BLACKHAWK BLVD APT 205
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-3433
Mailing Address - Country:US
Mailing Address - Phone:850-586-1712
Mailing Address - Fax:
Practice Address - Street 1:17201 BLACKHAWK BLVD APT 205
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3433
Practice Address - Country:US
Practice Address - Phone:850-586-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-22
Last Update Date:2018-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX952202163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse