Provider Demographics
NPI:1023406873
Name:BROKAMP, CRISTA LYNN (APRN, CNP)
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:LYNN
Last Name:BROKAMP
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:CRISTA
Other - Middle Name:LYNN
Other - Last Name:KOLDENHOVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:259 E ERIE ST STE 1950
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3907
Mailing Address - Country:US
Mailing Address - Phone:312-695-8143
Mailing Address - Fax:312-695-4075
Practice Address - Street 1:259 E ERIE ST STE 1950
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3907
Practice Address - Country:US
Practice Address - Phone:312-695-8143
Practice Address - Fax:312-695-4075
Is Sole Proprietor?:No
Enumeration Date:2015-01-02
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012348363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner