MEDICARE: ERIN BROOKE GEORGES 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	71005128A	IN
2	363L00000X	Nurse Practitioner	71005128A	IN

General Provider Information

NPI Number	:	1144622572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN BROOKE GEORGES FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1510
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47706-1510
Country	:	US
Telephone Number	:	812-868-0530
Fax Number	:	812-868-2188

Provider Business Practice Location Address
First Line	:	4949 HEALTHY WAY STE A
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-1180
Country	:	US
Telephone Number	:	812-868-0530
Fax Number	:	812-868-2188

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

Provider Enumeration Date	:	09/17/2014
Last Update Date	:	01/28/2020

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