Healthcare Provider Details

I. General information

NPI: 1376283192
Provider Name (Legal Business Name): NOVA BROOK MEBANE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 S PADRE ISLAND DR
CORPUS CHRISTI TX
78412-4913
US

IV. Provider business mailing address

7101 S PADRE ISLAND DR
CORPUS CHRISTI TX
78412-4913
US

V. Phone/Fax

Practice location:
  • Phone: 361-761-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV7579
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: