Healthcare Provider Details

I. General information

NPI: 1194949339
Provider Name (Legal Business Name): PHILIPPINE BROOKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 SE THIRD COURT
OCALA FL
34471-4118
US

IV. Provider business mailing address

2020 SE 17TH ST
OCALA FL
34471-4118
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-6474
  • Fax: 352-732-7205
Mailing address:
  • Phone: 352-861-0440
  • Fax: 352-861-1869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME 64858
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: