Individual
MRS. JESSICA NICOLE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
5955 AIRPORT BLVD, MOBILE, AL 36608
(251) 633-0573
(251) 633-7367
Mailing address
PO BOX 7987, MOBILE, AL 36670-0987
(251) 633-0573
(251) 633-7367
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1-106242
AL
363LA2100X
Acute Care Nurse Practitioner
Primary
1-106242
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02482035
MS MEDICAID
MS
01
—
102I502393
MEDICARE
AL
05
—
134189
—
AL
05
—
214094
—
AL
05
—
222576
—
AL
01
—
3092229
UHC
AL
01
—
510-49658
BCBS
AL
01
—
512-05477
BCBS
AL
01
—
512-05479
BCBS
AL
01
—
9582378
AETNA
AL
01
—
P00927530
RR MEDICARE
AL
01
—
Z12803
VIVA HEALTH
AL
Enumeration date
07/07/2009
Last updated
02/23/2024
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