Provider Demographics
NPI:1891682886
Name:BOLDEN, BROOKE NICOLE (NP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:BOLDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-4334
Mailing Address - Country:US
Mailing Address - Phone:678-925-0577
Mailing Address - Fax:
Practice Address - Street 1:146 SYLVAN DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1548
Practice Address - Country:US
Practice Address - Phone:770-775-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235702363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner