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General NPI Number Information
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NPI Number | 1962401554
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Entity Type | Individual
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Provider Name | BRIAN SCOTT BROOKS PA
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 22066 SE 71ST AVE
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City | HAWTHORNE
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State | FL
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Zip | 32640-3969
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Country | US
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Telephone | 352-481-2700
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Fax | 352-481-2392
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Provider Business Mailing Address
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Address Line | 1302 RIVER ST
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City | PALATKA
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State | FL
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Zip | 32177-5042
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Country | US
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Telephone | 386-326-7342
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Fax | 386-325-1086
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3061
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License Number State | FL
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