Healthcare Provider Details

I. General information

NPI: 1962992511
Provider Name (Legal Business Name): CAROLINE BROOKS DNP, FNP, CPNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 COLONY PARK DR STE 800
CUMMING GA
30040-2793
US

IV. Provider business mailing address

104 COLONY PARK DR STE 800
CUMMING GA
30040-2793
US

V. Phone/Fax

Practice location:
  • Phone: 678-947-4454
  • Fax:
Mailing address:
  • Phone: 847-361-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN282576
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9438175
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: