Healthcare Provider Details

I. General information

NPI: 1114274883
Provider Name (Legal Business Name): BROOKE M THOMAS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2012
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MULL AVE
AKRON OH
44313-7522
US

IV. Provider business mailing address

514 FOXBOROUGH DR
BRUNSWICK OH
44212-4343
US

V. Phone/Fax

Practice location:
  • Phone: 330-590-0847
  • Fax: 330-451-5782
Mailing address:
  • Phone: 440-666-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0029939
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN362959
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: