Healthcare Provider Details

I. General information

NPI: 1780268003
Provider Name (Legal Business Name): BROOKE FERNANDEZ ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BROOKE MILLER

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 CENTRAL PKWY
DELAND FL
32724-3372
US

IV. Provider business mailing address

1211 CENTRAL PKWY
DELAND FL
32724-3372
US

V. Phone/Fax

Practice location:
  • Phone: 352-978-8507
  • Fax:
Mailing address:
  • Phone: 352-978-8507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: