Healthcare Provider Details

I. General information

NPI: 1003109604
Provider Name (Legal Business Name): BROOKE AUSTIN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6101 PINE RIDGE RD 3RD FLOOR
NAPLES FL
34119-3900
US

IV. Provider business mailing address

6101 PINE RIDGE RD FL 3
NAPLES FL
34119-3900
US

V. Phone/Fax

Practice location:
  • Phone: 239-304-5161
  • Fax: 239-304-5193
Mailing address:
  • Phone: 239-566-8800
  • Fax: 239-566-8778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL-1745
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO3500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: