Provider Demographics
NPI:1881868552
Name:SPENCER, BROOKE HOLLAND (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:HOLLAND
Last Name:SPENCER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3670 S NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8596
Mailing Address - Country:US
Mailing Address - Phone:704-824-4560
Mailing Address - Fax:704-478-8194
Practice Address - Street 1:3670 S NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8596
Practice Address - Country:US
Practice Address - Phone:704-824-4560
Practice Address - Fax:704-478-8194
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2015-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5003951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2593284AMedicare UPIN