Healthcare Provider Details

I. General information

NPI: 1174926364
Provider Name (Legal Business Name): BROOKE ANN VELASQUEZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ANN BARNES PA-C

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7211 BANK CT
FREDERICK MD
21703-8483
US

IV. Provider business mailing address

1 FREDERICK HEALTH WAY
FREDERICK MD
21701-9435
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-6310
  • Fax: 240-566-7754
Mailing address:
  • Phone: 240-215-6310
  • Fax: 240-566-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010497
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5873
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13384
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: