Healthcare Provider Details

I. General information

NPI: 1952641680
Provider Name (Legal Business Name): BROOKE KERN BROCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE NICOLE KERN APRN

II. Dates (important events)

Enumeration Date: 02/16/2013
Last Update Date: 01/24/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 W HILLSBORO BLVD SUITE 207
COCONUT CREEK FL
33073-4395
US

IV. Provider business mailing address

5300 W HILLSBORO BLVD STE 207
COCONUT CREEK FL
33073-4397
US

V. Phone/Fax

Practice location:
  • Phone: 954-570-7644
  • Fax: 954-570-7884
Mailing address:
  • Phone: 954-570-7644
  • Fax: 954-570-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9295455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: