Healthcare Provider Details

I. General information

NPI: 1447061064
Provider Name (Legal Business Name): BROOKE A LATHON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 GODWIN BLVD STE 100
SUFFOLK VA
23434-8501
US

IV. Provider business mailing address

2760 GODWIN BLVD STE 100
SUFFOLK VA
23434-8501
US

V. Phone/Fax

Practice location:
  • Phone: 757-983-8650
  • Fax: 757-983-8673
Mailing address:
  • Phone: 757-983-8650
  • Fax: 757-983-8673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024086916
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: