MEDICARE: BROOKES MCCLELLAN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11031766	FL

General Provider Information

NPI Number	:	1598524449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKES MCCLELLAN ARNP

Provider Business Mailing Address
First Line	:	3295 HIGHWAY 185
Second Line	:
City	:	SAINT GEORGE
State	:	GA
Zip	:	31562-3515
Country	:	US
Telephone Number	:	904-403-4430
Fax Number	:

Provider Business Practice Location Address
First Line	:	9545 FL-228
Second Line	:
City	:	MACCLENNY
State	:	FL
Zip	:	32063
Country	:	US
Telephone Number	:	904-774-1041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2024
Last Update Date	:	03/14/2024

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