Provider Demographics
NPI:1790344000
Name:FOUNTAIN, BROOKE ERIN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ERIN
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6257 FM 2642 BLVD
Mailing Address - Street 2:
Mailing Address - City:ROYSE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75189-3223
Mailing Address - Country:US
Mailing Address - Phone:469-800-3670
Mailing Address - Fax:
Practice Address - Street 1:6257 FM 2642 BLVD
Practice Address - Street 2:
Practice Address - City:ROYSE CITY
Practice Address - State:TX
Practice Address - Zip Code:75189-3223
Practice Address - Country:US
Practice Address - Phone:469-800-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily