Provider Demographics
NPI:1194277798
Name:BROCIOUS, CHRISTINE RENEE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:RENEE
Last Name:BROCIOUS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4186 CORTLAND DR
Mailing Address - Street 2:
Mailing Address - City:NEW PARIS
Mailing Address - State:PA
Mailing Address - Zip Code:15554-7706
Mailing Address - Country:US
Mailing Address - Phone:814-839-4108
Mailing Address - Fax:814-839-4250
Practice Address - Street 1:4186 CORTLAND DR
Practice Address - Street 2:
Practice Address - City:NEW PARIS
Practice Address - State:PA
Practice Address - Zip Code:15554-7706
Practice Address - Country:US
Practice Address - Phone:814-839-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-29
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily