Individual
MRS. GINA R MIDDLEBROOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4075 COPPER RIDGE DR, TRAVERSE CITY, MI 49684-7059
(804) 289-4605
Mailing address
4075 COPPER RIDGE DR, TRAVERSE CITY, MI 49684-3689
(804) 289-4605
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
0024167368
VA
363L00000X
Nurse Practitioner
Primary
0024167368
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699965863
—
VA
Enumeration date
07/25/2007
Last updated
01/08/2010
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