Provider Demographics
NPI:1003216334
Name:BROOKS, NATASHA (APRN)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11653 SW 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-8747
Mailing Address - Country:US
Mailing Address - Phone:931-302-7720
Mailing Address - Fax:
Practice Address - Street 1:1355 COUNTY ROAD 222
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-8694
Practice Address - Country:US
Practice Address - Phone:931-302-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9196949163W00000X
FLAPRN11000013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11000013OtherDEPARTMENT OF HEALTH
FLRN9196949OtherDEPARTMENT OF HEALTH