Provider Demographics
NPI:1730457565
Name:BROOKS, TRESSIE DAWN SNIPES (APRN)
Entity type:Individual
Prefix:
First Name:TRESSIE
Middle Name:DAWN SNIPES
Last Name:BROOKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TRESSIE
Other - Middle Name:DAWN
Other - Last Name:SNIPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, APRN
Mailing Address - Street 1:450 NORTHSIDE CHEROKEE BLVD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8015
Mailing Address - Country:US
Mailing Address - Phone:770-224-1000
Mailing Address - Fax:770-224-2451
Practice Address - Street 1:450 NORTHSIDE CHEROKEE BLVD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8015
Practice Address - Country:US
Practice Address - Phone:770-224-1000
Practice Address - Fax:770-224-2451
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9243329363L00000X, 363LA2100X
GARN202650363LA2100X
GAGAA-NP002394363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108219600Medicaid