Healthcare Provider Details

I. General information

NPI: 1275471799
Provider Name (Legal Business Name): BROOKE ALEXIS ANTONITIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OSBORNE ST STE 121
DANBURY CT
06810-6019
US

IV. Provider business mailing address

19 DANBURY RD APT 9
RIDGEFIELD CT
06877-4028
US

V. Phone/Fax

Practice location:
  • Phone: 203-739-7038
  • Fax:
Mailing address:
  • Phone: 203-448-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10.151683
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: