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General NPI Number Information
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NPI Number | 1114741345
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Entity Type | Individual
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Provider Name | BROOKE MORGAN LAVINE
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Gender | Female
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 500 N FEDERAL HWY
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City | WEST PALM BEACH
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State | FL
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Zip | 33403-3598
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Country | US
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Telephone | 407-898-2767
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Fax |
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Provider Business Mailing Address
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Address Line | 19643 RUGGED TRUNK TRL
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-2143
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Country | US
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Telephone | 561-797-8760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 11035581
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License Number State | FL
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