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General NPI Number Information
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NPI Number | 1982365193
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Entity Type | Individual
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Provider Name | BROOK NICOLE EVANS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 5821 FAIRVIEW RD STE 200
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City | CHARLOTTE
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State | NC
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Zip | 28209-3649
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Country | US
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Telephone | 704-826-3550
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Fax | 704-538-4135
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Provider Business Mailing Address
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Address Line | 4705 UNIVERSITY DR BLDG 700
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City | DURHAM
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State | NC
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Zip | 27707-3489
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Country | US
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Telephone | 919-237-1337
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Fax | 866-538-4716
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00694400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-15013
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License Number State | NC
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