Healthcare Provider Details

I. General information

NPI: 1346112547
Provider Name (Legal Business Name): BROOKE DENNIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 W STATE ROAD 434 STE 1500
LONGWOOD FL
32779-5003
US

IV. Provider business mailing address

2160 W STATE ROAD 434 STE 1500
LONGWOOD FL
32779-5003
US

V. Phone/Fax

Practice location:
  • Phone: 407-862-3400
  • Fax: 407-862-6277
Mailing address:
  • Phone: 407-862-3400
  • Fax: 407-862-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: