=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467593525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LATINA BROOKS CNP, PHD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2007
-----------------------------------------------------
Last Update Date | 02/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20050 HARVARD AVE SUITE 300
-----------------------------------------------------
City | WARRENSVILLE HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-6816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-921-1650
-----------------------------------------------------
Fax | 216-921-2358
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 LITERARY RD
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44113-4537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-344-2208
-----------------------------------------------------
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 | NP-05284
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | NP-05284
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------