Healthcare Provider Details

I. General information

NPI: 1093373052
Provider Name (Legal Business Name): ANNA MARIE BROOKS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295B S JACKSON ST
GROVE HILL AL
36451-3231
US

IV. Provider business mailing address

PO BOX 915
GROVE HILL AL
36451-0915
US

V. Phone/Fax

Practice location:
  • Phone: 251-275-3173
  • Fax: 251-275-3110
Mailing address:
  • Phone: 251-275-3173
  • Fax: 251-275-3110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-137174
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: