Healthcare Provider Details

I. General information

NPI: 1417752940
Provider Name (Legal Business Name): BROOKE AUSTIN HOLCOMB PMH-RN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 BIRDNECK CIR
VIRGINIA BEACH VA
23451-5516
US

IV. Provider business mailing address

409 BIRDNECK CIR STE 126
VIRGINIA BEACH VA
23451-5516
US

V. Phone/Fax

Practice location:
  • Phone: 757-385-0511
  • Fax:
Mailing address:
  • Phone: 757-385-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number0001263108
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0001263108
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: