MEDICARE: MRS. JENNIFER MARIE BROOKS AGNP

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	1087019	TX
2	363LG0600X	Gerontology Nurse Practitioner	1087019	TX

General Provider Information

NPI Number	:	1760118582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARIE BROOKS AGNP

Provider Business Mailing Address
First Line	:	2828 WOODPATH LN
Second Line	:
City	:	BEDFORD
State	:	TX
Zip	:	76021-2745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13737 NOEL RD STE 1400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-2004
Country	:	US
Telephone Number	:	469-518-4823
Fax Number	:

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

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	02/11/2026

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