Healthcare Provider Details

I. General information

NPI: 1407448640
Provider Name (Legal Business Name): BROOKE ASHLEY WATSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12280 LAKE UNDERHILL RD
ORLANDO FL
32825-5009
US

IV. Provider business mailing address

2090 S HIGHWAY 29
CANTONMENT FL
32533-8699
US

V. Phone/Fax

Practice location:
  • Phone: 850-937-0122
  • Fax:
Mailing address:
  • Phone: 850-937-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0041527
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0013681
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-85290-062
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11011469
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN05061
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: