Provider Demographics
NPI:1699195883
Name:BROCK, AIMEE NICOLE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:NICOLE
Last Name:BROCK
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 NICKERSON AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-3270
Mailing Address - Country:US
Mailing Address - Phone:606-248-2739
Mailing Address - Fax:
Practice Address - Street 1:123 N 19TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2865
Practice Address - Country:US
Practice Address - Phone:606-248-2739
Practice Address - Fax:606-248-2730
Is Sole Proprietor?:No
Enumeration Date:2014-04-26
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008525363LF0000X
TNAPN18437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01983681OtherRR MEDICARE
TNQ030733Medicaid