Provider Demographics
NPI:1982695920
Name:BROOKS, JANA MICHELLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:MICHELLE
Last Name:BROOKS
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:PO BOX 601448
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1448
Mailing Address - Country:US
Mailing Address - Phone:704-543-6636
Mailing Address - Fax:704-541-9476
Practice Address - Street 1:7810 PROVIDENCE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2987
Practice Address - Country:US
Practice Address - Phone:704-543-6636
Practice Address - Fax:704-541-9476
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005796Medicaid
NCNC5137KMedicare PIN
NC7005796Medicaid
NCNC5137LMedicare PIN
NCNC5137IMedicare PIN
NCNC5137HMedicare PIN
NCNC5137JMedicare PIN
NCNC5137AMedicare PIN
NCNC5137BMedicare PIN
NCNC5137GMedicare PIN
NCNC5137FMedicare PIN
NCNC5137DMedicare PIN
NCNC5137EMedicare PIN