Provider Demographics
NPI:1821814906
Name:WHITE, BROOKE NICOLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:WHITE
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 BANKS LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2643
Mailing Address - Country:US
Mailing Address - Phone:517-917-5388
Mailing Address - Fax:
Practice Address - Street 1:969 BANKS LN
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-2643
Practice Address - Country:US
Practice Address - Phone:517-917-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-23
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24191846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily