=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235887118
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROOKE LAMOUR LOUNSBURY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2022
-----------------------------------------------------
Last Update Date | 09/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6080 SW 83RD PL
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32693-0030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-246-8566
-----------------------------------------------------
Fax | 734-322-0384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6080 SW 83RD PL
-----------------------------------------------------
City | TRENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32693-0030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-231-3282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11030500
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 9478475
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------