Healthcare Provider Details

I. General information

NPI: 1053169474
Provider Name (Legal Business Name): BROOKE JUNEAU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2024
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 E BAY DR
LARGO FL
33771-2213
US

IV. Provider business mailing address

1775 E BAY DR
LARGO FL
33771-2213
US

V. Phone/Fax

Practice location:
  • Phone: 727-441-1508
  • Fax:
Mailing address:
  • Phone: 727-441-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11049432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: