Provider Demographics
NPI:1720829294
Name:SNOW, BROOKE ANN (FNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:SNOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ANN
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18930 PIMLICO RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-6782
Mailing Address - Country:US
Mailing Address - Phone:909-489-0922
Mailing Address - Fax:
Practice Address - Street 1:18182 US HIGHWAY 18 STE 106
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2200
Practice Address - Country:US
Practice Address - Phone:760-503-6116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily