Healthcare Provider Details

I. General information

NPI: 1225969876
Provider Name (Legal Business Name): BROOKE ALEXIS BARBER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 CORAL RIDGE DR STE 314
CORAL SPRINGS FL
33076-3380
US

IV. Provider business mailing address

4279 SW 130TH AVE
DAVIE FL
33330-4729
US

V. Phone/Fax

Practice location:
  • Phone: 754-229-6928
  • Fax:
Mailing address:
  • Phone: 954-242-0967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4758
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: