Provider Demographics
NPI:1912339516
Name:BROCK, ABIGAIL LYNN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:LYNN
Last Name:BROCK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:LYNN
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-9870
Mailing Address - Fax:256-265-9875
Practice Address - Street 1:8489 MADISON BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2005
Practice Address - Country:US
Practice Address - Phone:256-850-8400
Practice Address - Fax:256-850-8401
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-101695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily