Healthcare Provider Details

I. General information

NPI: 1538677257
Provider Name (Legal Business Name): JULIE ANNE BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

IV. Provider business mailing address

2533 VICARA CT
ROYAL PALM BEACH FL
33411-1480
US

V. Phone/Fax

Practice location:
  • Phone: 954-939-7494
  • Fax:
Mailing address:
  • Phone: 561-312-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2509732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: