Healthcare Provider Details

I. General information

NPI: 1730944471
Provider Name (Legal Business Name): BROOKE SNELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SE INDIAN ST STE 4
STUART FL
34997-5565
US

IV. Provider business mailing address

650 SE INDIAN ST STE 4
STUART FL
34997-5565
US

V. Phone/Fax

Practice location:
  • Phone: 772-403-2229
  • Fax: 772-403-2230
Mailing address:
  • Phone: 772-403-2229
  • Fax: 772-403-2230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118443
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA9118443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: