Healthcare Provider Details

I. General information

NPI: 1053843664
Provider Name (Legal Business Name): BROOKE GRAVES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE GRAVES PA-C

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 COLLEGE DR
FLAT ROCK NC
28731-7756
US

IV. Provider business mailing address

3800 S OCEAN DR STE 209
HOLLYWOOD FL
33019-2915
US

V. Phone/Fax

Practice location:
  • Phone: 800-226-8874
  • Fax:
Mailing address:
  • Phone: 800-226-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001007169
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: