Healthcare Provider Details

I. General information

NPI: 1376258525
Provider Name (Legal Business Name): BROOKE ASHLEY FRANKS-JACOBUCCI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BROOKE BLANCHARD

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 JOHN PLATT DR
MOREHEAD CITY NC
28557-4372
US

IV. Provider business mailing address

916 GUM BRANCH CT
HAVELOCK NC
28532-3233
US

V. Phone/Fax

Practice location:
  • Phone: 252-777-3140
  • Fax:
Mailing address:
  • Phone: 219-802-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2832245
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB-ID-892808
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: