Healthcare Provider Details

I. General information

NPI: 1457190852
Provider Name (Legal Business Name): BROOKE CLAIRE O'LAUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10293 SOLTURA DR
FORT MYERS FL
33905-5998
US

IV. Provider business mailing address

10293 SOLTURA DR
FORT MYERS FL
33905-5998
US

V. Phone/Fax

Practice location:
  • Phone: 772-485-0070
  • Fax:
Mailing address:
  • Phone: 772-485-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9529528
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9529528
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: