Healthcare Provider Details

I. General information

NPI: 1821907171
Provider Name (Legal Business Name): NICHOLE BROOKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7173 S HAVANA ST STE 600-220
CENTENNIAL CO
80112-3891
US

IV. Provider business mailing address

9331 AUTUMN ASH CT
HIGHLANDS RANCH CO
80126-8612
US

V. Phone/Fax

Practice location:
  • Phone: 303-229-3678
  • Fax:
Mailing address:
  • Phone: 303-229-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW-466
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCPFS-2851
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: