MEDICARE: ANGELINA NICOLE HOLBROOK APRN FNP-C

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
1	363LF0000X	Family Nurse Practitioner	APRN.CNP.0027749	OH

General Provider Information

NPI Number	:	1114526662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELINA NICOLE HOLBROOK APRN FNP-C

Provider Business Mailing Address
First Line	:	601 N BREIEL BLVD
Second Line	:	SUITE B
City	:	MIDDLETOWN
State	:	OH
Zip	:	45042
Country	:	US
Telephone Number	:	513-454-1111
Fax Number	:	513-433-0515

Provider Business Practice Location Address
First Line	:	69 BAYBERRY LN
Second Line	:
City	:	MONROE
State	:	OH
Zip	:	45050-2521
Country	:	US
Telephone Number	:	513-291-3499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2020
Last Update Date	:	03/05/2026

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