Healthcare Provider Details

I. General information

NPI: 1114526662
Provider Name (Legal Business Name): ANGELINA NICOLE HOLBROOK APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2020
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 BAYBERRY LN
MONROE OH
45050-2521
US

IV. Provider business mailing address

601 N BREIEL BLVD SUITE B
MIDDLETOWN OH
45042
US

V. Phone/Fax

Practice location:
  • Phone: 513-291-3499
  • Fax:
Mailing address:
  • Phone: 513-454-1111
  • Fax: 513-433-0515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027749
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: