Individual
MR. DEREK JASON BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
149 E SIMPSON ST, ALLIANCE, OH 44601-4219
(330) 823-3856
(330) 829-6688
Mailing address
PO BOX 932100, CLEVELAND, OH 44193-0008
(216) 472-2730
(216) 472-2740
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
COA.15415-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0095680
—
OH
Enumeration date
11/22/2013
Last updated
07/01/2015
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