Healthcare Provider Details

I. General information

NPI: 1063905560
Provider Name (Legal Business Name): BROOKE M PALMER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2018
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 VETERANS WAY
PENSACOLA FL
32507-1000
US

IV. Provider business mailing address

790 VETERANS WAY
PENSACOLA FL
32507-1000
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005763RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: