Provider Demographics
NPI:1821574336
Name:BROOKS, NICOLE A (ARNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13801 BRUCE B DOWNS BLVD STE 406
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3923
Mailing Address - Country:US
Mailing Address - Phone:813-444-0989
Mailing Address - Fax:863-248-8279
Practice Address - Street 1:13801 BRUCE B DOWNS BLVD STE 406
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3923
Practice Address - Country:US
Practice Address - Phone:813-444-0989
Practice Address - Fax:863-248-8279
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9267840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily