Healthcare Provider Details

I. General information

NPI: 1215283098
Provider Name (Legal Business Name): NICHOLAS FRANKLIN BROOKINS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2012
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 SANTA FE DR STE 7
PUEBLO CO
81006-1497
US

IV. Provider business mailing address

PO BOX 9000
PUEBLO CO
81008-9000
US

V. Phone/Fax

Practice location:
  • Phone: 719-553-2206
  • Fax: 833-916-2053
Mailing address:
  • Phone: 719-553-2206
  • Fax: 833-916-2053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0992953
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: