Healthcare Provider Details

I. General information

NPI: 1780274829
Provider Name (Legal Business Name): BROOKE ASHLEY MICHAEL DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS BROOKE ASHLEY CAMPBELL

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 SEA ISLAND PKWY
LADYS ISLAND SC
29907-1503
US

IV. Provider business mailing address

179 PLEASANT POINT DR
BEAUFORT SC
29907-1117
US

V. Phone/Fax

Practice location:
  • Phone: 843-322-1933
  • Fax:
Mailing address:
  • Phone: 330-428-4187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24507
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: