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General NPI Number Information
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NPI Number | 1174022743
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Entity Type | Individual
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Provider Name | ANDREW RONALD BRAKE FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 02/08/2018
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1210 NEW GARDEN RD
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City | GREENSBORO
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State | NC
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Zip | 27410
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Country | US
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Telephone | 336-294-6190
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Fax | 336-294-6278
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Provider Business Mailing Address
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Address Line | 3305 FARM LAKE ST
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City | JAMESTOWN
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State | NC
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Zip | 27282-7514
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 269582
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 269582
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 269582
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License Number State | NC
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