Individual
AMANDA L BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, APRN, FNP-C
Contact information
Practice address
110 DUBLIN DR STE A, DOVER, OH 44622-7805
(330) 364-8038
Mailing address
659 BOULEVARD ST, DOVER, OH 44622-2026
(330) 602-0770
(330) 602-0770
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
341552
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
H2298500095054
—
OH
Enumeration date
10/14/2013
Last updated
05/22/2019
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