MEDICARE: MRS. LISA M BROOKS APRN-BC

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	363L00000X	Nurse Practitioner	7396	TN
2	363LA2100X	Acute Care Nurse Practitioner	7396	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00682288	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396888178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA M BROOKS APRN-BC

Provider Business Mailing Address
First Line	:	4976 ALPHA LN
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-5470
Country	:	US
Telephone Number	:	423-497-5355
Fax Number	:	423-497-5355

Provider Business Practice Location Address
First Line	:	1700 BROAD ST STE 140
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37408-1834
Country	:	US
Telephone Number	:	423-654-4380
Fax Number	:

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	09/09/2024

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