Provider Demographics
NPI:1003109604
Name:AUSTIN, BROOKE (DPM)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 PINE RIDGE RD
Mailing Address - Street 2:FL 3
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3900
Mailing Address - Country:US
Mailing Address - Phone:239-566-8800
Mailing Address - Fax:239-566-8778
Practice Address - Street 1:6101 PINE RIDGE RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-304-5161
Practice Address - Fax:239-304-5193
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL-1745213ES0103X
FLPO3500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery