Healthcare Provider Details

I. General information

NPI: 1912968157
Provider Name (Legal Business Name): SHANNON KRISTINE BROOKS APRN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 800-243-3839
  • Fax:
Mailing address:
  • Phone: 800-243-3839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number597062
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number597062
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: