Healthcare Provider Details

I. General information

NPI: 1164289070
Provider Name (Legal Business Name): LAURA B. BROOKS MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CEDAR AVE
WEST LONG BRANCH NJ
07764-1804
US

IV. Provider business mailing address

400 CEDAR AVE
WEST LONG BRANCH NJ
07764-1898
US

V. Phone/Fax

Practice location:
  • Phone: 732-571-3464
  • Fax:
Mailing address:
  • Phone: 732-571-3464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number26NJ15009900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: