Healthcare Provider Details

I. General information

NPI: 1972229169
Provider Name (Legal Business Name): BROOKE ALISON WIMBERLEY DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 06/29/2025
Certification Date: 06/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 SILVER LN
SAINT AUGUSTINE FL
32084-3922
US

IV. Provider business mailing address

279 DEER CROSSING RD
SAINT AUGUSTINE FL
32086-8408
US

V. Phone/Fax

Practice location:
  • Phone: 904-640-2000
  • Fax:
Mailing address:
  • Phone: 386-546-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11020307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: