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General NPI Number Information
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NPI Number | 1821828492
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Entity Type | Individual
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Provider Name | JENEE BROCK
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Gender | Female
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Dates
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Enumeration Date | 08/07/2024
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 4295 HEMPSTEAD TPKE
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City | BETHPAGE
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State | NY
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Zip | 11714-5713
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Country | US
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Telephone | 904-372-3943
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Fax | 904-212-1618
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Provider Business Mailing Address
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Address Line | 7751 BELFORT PKWY STE 120
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6921
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Country | US
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Telephone | 904-372-3943
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Fax | 904-212-1618
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 747933
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 354940
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 354940
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License Number State | NY
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