Provider Demographics
NPI:1023848546
Name:BROCKMAN, TAJA M
Entity type:Individual
Prefix:
First Name:TAJA
Middle Name:M
Last Name:BROCKMAN
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 1:1705 ANDREWS AVE S APT 6A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-0479
Mailing Address - Country:US
Mailing Address - Phone:347-543-7520
Mailing Address - Fax:
Practice Address - Street 1:1705 ANDREWS AVE S APT 6A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-0479
Practice Address - Country:US
Practice Address - Phone:347-543-7520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula