Healthcare Provider Details

I. General information

NPI: 1922525153
Provider Name (Legal Business Name): BROOKE BASFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 482 BOX 1600
FPO AP
96362-9998
US

IV. Provider business mailing address

PSC 1005 BOX 110185
FPO AA
34009
US

V. Phone/Fax

Practice location:
  • Phone: 850-502-8062
  • Fax:
Mailing address:
  • Phone: 757-695-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9283274
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9283274
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: