Provider Demographics
NPI:1679248546
Name:FORMAN, ERIN BROOKS (FNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:BROOKS
Last Name:FORMAN
Suffix:
Gender:F
Credentials:FNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 DEXTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5562
Mailing Address - Country:US
Mailing Address - Phone:972-490-9500
Mailing Address - Fax:
Practice Address - Street 1:4716 DEXTER DR STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5562
Practice Address - Country:US
Practice Address - Phone:972-490-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142938363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily