Provider Demographics
NPI:1245918762
Name:COLLIGAN, BROOKE A (NP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:A
Last Name:COLLIGAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 NANTAHALA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-7336
Mailing Address - Country:US
Mailing Address - Phone:805-259-5295
Mailing Address - Fax:
Practice Address - Street 1:13300 STRICKLAND RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-5220
Practice Address - Country:US
Practice Address - Phone:919-385-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily