Healthcare Provider Details
I. General information
NPI: 1821814906
Provider Name (Legal Business Name): BROOKE NICOLE WHITE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 11/23/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
8484 PATRICK HENRY WAY
GLOUCESTER VA
23061-5398
US
IV. Provider business mailing address
8484 PATRICK HENRY WAY
GLOUCESTER VA
23061-5398
US
V. Phone/Fax
- Phone: 517-917-5388
- Fax:
- Phone: 517-917-5388
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 24191846 |
| License Number State | VA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: