Provider Demographics
NPI:1699078980
Name:BROCK, CORINNE MARY (FNP-C, MPH)
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:MARY
Last Name:BROCK
Suffix:
Gender:F
Credentials:FNP-C, MPH
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:MARY
Other - Last Name:SELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1925 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3128
Mailing Address - Country:US
Mailing Address - Phone:720-494-3121
Mailing Address - Fax:720-494-3108
Practice Address - Street 1:1925 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501
Practice Address - Country:US
Practice Address - Phone:720-494-3121
Practice Address - Fax:720-494-3108
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0991380-NP363L00000X, 363LF0000X
CORN.1619905163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse