Provider Demographics
NPI:1578918967
Name:BROCKINGTON, NATASHA RENEE (APRN)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:RENEE
Last Name:BROCKINGTON
Suffix:
Gender:F
Credentials:APRN
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Other - Credentials:
Mailing Address - Street 1:AGAPE SENIOR PRIMARY CARE, INC.
Mailing Address - Street 2:1624 MAIN STREET
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2818
Mailing Address - Country:US
Mailing Address - Phone:803-726-2283
Mailing Address - Fax:803-753-9102
Practice Address - Street 1:AGAPE SENIOR PRIMARY CARE, INC.
Practice Address - Street 2:1624 MAIN STREET SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2860
Practice Address - Country:US
Practice Address - Phone:803-451-6133
Practice Address - Fax:803-726-2210
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC20143363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily