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NPI Code Detail

MEDICARE: BROOKE ANNE BOCCACCIO PMHNP

MEDICARE: BROOKE ANNE BOCCACCIO PMHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN224129GA
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN-NP224129GA

General Provider Information

NPI Number : 1093203465
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE ANNE BOCCACCIO PMHNP
Provider Business Mailing Address
First Line : 2801 BUFORD HWY NE STE 100
Second Line :
City : BROOKHAVEN
State : GA
Zip : 30329-2146
Country : US
Telephone Number : 678-820-7830
Fax Number : 678-373-0339
Provider Business Practice Location Address
First Line : 2801 BUFORD HWY NE STE 100
Second Line :
City : BROOKHAVEN
State : GA
Zip : 30329-2146
Country : US
Telephone Number : 678-820-7830
Fax Number : 678-373-0339
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2018
Last Update Date : 10/23/2025

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Directions to “ BROOKE ANNE BOCCACCIO PMHNP” Practice Location

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