Healthcare Provider Details

I. General information

NPI: 1558970459
Provider Name (Legal Business Name): BROOKE SOLANO STAUBUS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 CENTER PLACE WAY
ST AUGUSTINE FL
32095-8859
US

IV. Provider business mailing address

3372 CANYON FALLS DR
GREEN COVE SPRINGS FL
32043-9228
US

V. Phone/Fax

Practice location:
  • Phone: 904-342-9245
  • Fax:
Mailing address:
  • Phone: 904-342-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-43447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: