Individual provider Active NPI

Nicole Marie Brubaker, FNP-C

  • Family Nurse Practitioner
  • Sandy Creek, NY
National Provider Identifier
1003267345
Registry record updated Jun 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
33 340733 Issued in NY
Practice address
124 Salisbury St
Sandy Creek, NY 13145-7706
Phone
(315) 387-3620
NPI assigned
Jun 28, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 33 340733 NY Primary

Addresses

Primary practice location

124 Salisbury St
Sandy Creek, NY 13145-7706

Mailing address

61 Delano St
Pulaski, NY 13142-1400
Phone (315) 298-6564

Other practice location 1

61 Delano St
Pulaski, NY 13142-1400
Phone (315) 298-6564

Other identifiers 1

IdentifierTypeStateIssuer
04550890MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160913000009 NY Practitioner - Nurse Practitioner 6204122534 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
33 340733NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Oswego County Health Services, Inc. CurrentSince Aug 13, 2020 Accepting new patients

Locations

3045 East Ave
Central Square, NY 13036
Phone (315) 668-1202

61 Delano St
Pulaski, NY 13142
Phone (315) 298-4274

Interoperability endpoints

  • Direct secure messaging: nbrubaker@oswegohealth.hiemail.healtheconnections.org
  • Direct secure messaging: nicole.brubaker@nochsi.directbygreenway.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1467072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750291200000",
    "number": "1003267345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 DELANO ST",
            "city": "PULASKI",
            "state": "NY",
            "postal_code": "131421400",
            "telephone_number": "315-298-6564",
            "fax_number": "315-298-3968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 SALISBURY ST",
            "city": "SANDY CREEK",
            "state": "NY",
            "postal_code": "131457706",
            "telephone_number": "315-387-3620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "61 Delano St",
            "address_purpose": "LOCATION",
            "city": "Pulaski",
            "state": "NY",
            "postal_code": "131421400",
            "country_code": "US",
            "telephone_number": "315-298-6564",
            "fax_number": "315-298-3968",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRUBAKER",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-28",
        "last_updated": "2025-06-19",
        "certification_date": "2025-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "33 340733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04550890",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandy Creek, NY

Sources for this page

Verify at the official NPI Registry.