Healthcare Provider Details

I. General information

NPI: 1518843960
Provider Name (Legal Business Name): ANNETTE BOBBIE SANDOVAL BROOKS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6286 CAMEO WAY
TRACY CA
95377-8679
US

IV. Provider business mailing address

6286 CAMEO WAY
TRACY CA
95377-8679
US

V. Phone/Fax

Practice location:
  • Phone: 720-297-0417
  • Fax:
Mailing address:
  • Phone: 720-297-0417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number95035490
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95035490
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: