MEDICARE: SANDRA L BROOKS 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	2650922	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1790783207	OTHER	FL	MEDICARE PTAN Y4188Y

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790783207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA L BROOKS ARNP

Provider Business Mailing Address
First Line	:	533 N NOVA RD STE 203
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-4422
Country	:	US
Telephone Number	:	386-672-7175
Fax Number	:	386-672-0771

Provider Business Practice Location Address
First Line	:	533 N NOVA RD STE 203
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-4422
Country	:	US
Telephone Number	:	386-672-7175
Fax Number	:	386-672-0771

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	12/22/2016

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