Provider Demographics
NPI:1952865768
Name:BROOKS, NICOLE MARISA
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARISA
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARK HILL DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3357
Mailing Address - Country:US
Mailing Address - Phone:540-371-3010
Mailing Address - Fax:
Practice Address - Street 1:101 PARK HILL DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3357
Practice Address - Country:US
Practice Address - Phone:540-371-3010
Practice Address - Fax:540-899-9821
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001211751163W00000X
VA0024177362363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse