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General NPI Number Information
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NPI Number | 1659821973
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Entity Type | Individual
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Provider Name | GINA BROOKS FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/11/2016
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 21 E STATE ST
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City | COLUMBUS
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State | OH
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Zip | 43215-4281
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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Provider Business Mailing Address
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Address Line | PO BOX 10299
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City | FORT WAYNE
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State | IN
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Zip | 46851-0299
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Country | US
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Telephone | 574-546-1900
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Fax | 574-546-1999
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.019312
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License Number State | OH
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