Provider Demographics
NPI:1295339208
Name:NASSER, BROOKE ELISE (FNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELISE
Last Name:NASSER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ELISE
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6784 SHOOTING STAR DR
Mailing Address - Street 2:
Mailing Address - City:WHITESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:46075-6213
Mailing Address - Country:US
Mailing Address - Phone:812-236-2204
Mailing Address - Fax:
Practice Address - Street 1:5926 CRAWFORDSVILLE RD UNIT B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-3722
Practice Address - Country:US
Practice Address - Phone:317-268-5741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28229877A163W00000X
IN71010968A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse