Provider Demographics
NPI:1720226228
Name:BROOKER, NICOLE ANN (PMHNP, AGPCNP, BSN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:BROOKER
Suffix:
Gender:F
Credentials:PMHNP, AGPCNP, BSN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:BROOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:3134 WENDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-7271
Mailing Address - Country:US
Mailing Address - Phone:919-374-7285
Mailing Address - Fax:
Practice Address - Street 1:3134 WENDELL BLVD
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-7271
Practice Address - Country:US
Practice Address - Phone:919-374-7283
Practice Address - Fax:919-374-7285
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-22
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006823363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner