Provider Demographics
NPI:1710143284
Name:BROOKS, MICHAL L (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MICHAL
Middle Name:L
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:MIKKI
Other - Middle Name:L
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 W MORRIS BLVD
Mailing Address - Street 2:HEALTHSTAR PHYSICIANS STE 400B
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2283
Mailing Address - Country:US
Mailing Address - Phone:423-586-2410
Mailing Address - Fax:423-581-9692
Practice Address - Street 1:420 W MORRIS BLVD
Practice Address - Street 2:HEALTHSTAR PHYSICIANS STE 400B
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813-2283
Practice Address - Country:US
Practice Address - Phone:423-586-2410
Practice Address - Fax:423-581-9692
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510186Medicaid
TN1510186Medicaid