Provider Demographics
NPI:1144810524
Name:BROCK, ANGELA DENISE (APRN)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DENISE
Last Name:BROCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6064 S FORT APACHE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5350
Mailing Address - Country:US
Mailing Address - Phone:702-940-8007
Mailing Address - Fax:
Practice Address - Street 1:6064 S FORT APACHE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5350
Practice Address - Country:US
Practice Address - Phone:702-940-8007
Practice Address - Fax:702-832-1940
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV837250363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner