Healthcare Provider Details

I. General information

NPI: 1760293187
Provider Name (Legal Business Name): BROOK NAPLES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 W OLIVE AVE STE B
MERCED CA
95348-3181
US

IV. Provider business mailing address

PO BOX 3768
MERCED CA
95344-3768
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-3076
  • Fax: 209-383-5464
Mailing address:
  • Phone: 209-725-7149
  • Fax: 209-726-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: