Provider Demographics
NPI:1821495425
Name:COYNE, BROOKE BROWN (AGPCNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:BROWN
Last Name:COYNE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 NORTHBROOK BLVD
Mailing Address - Street 2:SUITE A20
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9252
Mailing Address - Country:US
Mailing Address - Phone:803-236-8210
Mailing Address - Fax:
Practice Address - Street 1:2070 NORTHBROOK BLVD
Practice Address - Street 2:SUITE A20
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9252
Practice Address - Country:US
Practice Address - Phone:803-236-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19166363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner