Provider Demographics
NPI:1609402429
Name:BROCK, NAKLESA TONETTE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NAKLESA
Middle Name:TONETTE
Last Name:BROCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 CLOVERHILLS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4027
Mailing Address - Country:US
Mailing Address - Phone:502-759-3381
Mailing Address - Fax:
Practice Address - Street 1:1403 CLOVERHILLS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4027
Practice Address - Country:US
Practice Address - Phone:502-759-3381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily