Provider Demographics
NPI:1366995177
Name:BROOKS, JILLIAN ROSE (MS, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JILLIAN
Middle Name:ROSE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS, APRN, FNP-C
Other - Prefix:MS
Other - First Name:JILLIAN
Other - Middle Name:ROSE
Other - Last Name:BALCEWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, APRN, FNP-C
Mailing Address - Street 1:100 INSTITUTE ROAD
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2280
Mailing Address - Country:US
Mailing Address - Phone:508-831-5520
Mailing Address - Fax:
Practice Address - Street 1:32 HACKFELD ROAD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2280
Practice Address - Country:US
Practice Address - Phone:508-831-5520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2296605363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner