Provider Demographics
NPI:1184190647
Name:BROSKE, MELISSA RENEE (APRN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:BROSKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:RENEE
Other - Last Name:THAKORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:614 MULLINS COLONY DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-0579
Mailing Address - Country:US
Mailing Address - Phone:706-760-7272
Mailing Address - Fax:706-760-7276
Practice Address - Street 1:614 MULLINS COLONY DR
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-0579
Practice Address - Country:US
Practice Address - Phone:706-760-7272
Practice Address - Fax:706-760-7276
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANP217143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily