Healthcare Provider Details

I. General information

NPI: 1407597297
Provider Name (Legal Business Name): HEATHER ELIZABETH BROOKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 BROOKWOOD AVE
JACKSON GA
30233-1460
US

IV. Provider business mailing address

643 MAIN ST
PALMETTO GA
30268-1138
US

V. Phone/Fax

Practice location:
  • Phone: 678-752-0555
  • Fax:
Mailing address:
  • Phone: 404-929-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN164499
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: