Healthcare Provider Details

I. General information

NPI: 1952865768
Provider Name (Legal Business Name): NICOLE MARISA BROOKS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PARK HILL DR
FREDERICKSBURG VA
22401-3357
US

IV. Provider business mailing address

101 PARK HILL DR
FREDERICKSBURG VA
22401-3357
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-3010
  • Fax: 540-899-9821
Mailing address:
  • Phone: 540-371-3010
  • Fax: 540-899-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001211751
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024177362
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: