Healthcare Provider Details

I. General information

NPI: 1144961475
Provider Name (Legal Business Name): BROCK FAMILY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 SHILOH RD
FOREST CITY NC
28043-6958
US

IV. Provider business mailing address

289 SHILOH RD
FOREST CITY NC
28043-6958
US

V. Phone/Fax

Practice location:
  • Phone: 828-382-7282
  • Fax: 828-744-0001
Mailing address:
  • Phone: 828-382-7282
  • Fax: 828-744-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAMILA ALMEIDA GUERRERO
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 828-305-7787