Doctor Name: | TRACI L. BROOKS |
NPI Number: | 1528247178 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, FNP-C |
License Number: | 663922 |
Business Practice Address: | 480 Central Ave Family Practice Clinic Jbphh, HI - 968604908 |
Business Phone Number: | 8082573365 |
Business Fax Number: | |
Mailing Address: | 480 Central Ave, Family Practice Clinic JBPHH |
State: | HI |
Postal Code: | 968604908 |
Phone Number: | 8082573365 |
Fax Number: | |
NPI Enumeration Date: | 10/31/2007 |
NPI Last Update Date: | 12/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 663922 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |