Healthcare Provider Details

I. General information

NPI: 1598170805
Provider Name (Legal Business Name): JENNY BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 N LEE ST SUITE 203
JACKSONVILLE FL
32204-1128
US

IV. Provider business mailing address

425 N LEE ST SUITE 203
JACKSONVILLE FL
32204-1128
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-6900
  • Fax: 904-308-6927
Mailing address:
  • Phone: 904-308-6900
  • Fax: 904-308-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9270653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: