Provider Demographics
NPI:1760281299
Name:BRUST, NICHOLAS QUINN (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:QUINN
Last Name:BRUST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-3509
Mailing Address - Country:US
Mailing Address - Phone:830-734-6667
Mailing Address - Fax:
Practice Address - Street 1:8708 E 25TH DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2751
Practice Address - Country:US
Practice Address - Phone:830-734-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-08
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical