Provider Demographics
NPI:1578368817
Name:BROOKS, GINA (FNP-BC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CARLA TER
Mailing Address - Street 2:
Mailing Address - City:PINE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12567-5101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1561 ULSTER AVE
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5173
Practice Address - Country:US
Practice Address - Phone:845-231-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356147363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily