Healthcare Provider Details

I. General information

NPI: 1699693739
Provider Name (Legal Business Name): TORA MONIQUE BROCKERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 RHODES AVE
WINDSOR NC
27983-9656
US

IV. Provider business mailing address

602 WOODARD RD
WINDSOR NC
27983-8950
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-3042
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06261993
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: