MEDICARE: JUSTINE DIANE BROOKINS NP

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	363L00000X	Nurse Practitioner	1-150193	AL

General Provider Information

NPI Number	:	1730985953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINE DIANE BROOKINS NP

Provider Business Mailing Address
First Line	:	1837 UPPER WETUMPKA RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36107-1333
Country	:	US
Telephone Number	:	334-450-8012
Fax Number	:

Provider Business Practice Location Address
First Line	:	1837 UPPER WETUMPKA RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36107-1304
Country	:	US
Telephone Number	:	334-264-8416
Fax Number	:

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

Provider Enumeration Date	:	02/19/2025
Last Update Date	:	02/19/2025

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