Provider Demographics
NPI:1811788219
Name:BROCK, CHRISTINE (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 BOYD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-8147
Mailing Address - Country:US
Mailing Address - Phone:910-719-1601
Mailing Address - Fax:
Practice Address - Street 1:696 MUCKERMAN RD
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-6195
Practice Address - Country:US
Practice Address - Phone:843-454-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022006363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner