Provider Demographics
NPI:1033801915
Name:JOHNSON, BROOKE ANNA
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4215 BURNS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4625
Mailing Address - Country:US
Mailing Address - Phone:561-694-3099
Mailing Address - Fax:561-694-3099
Practice Address - Street 1:4215 BURNS RD STE 100
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4627
Practice Address - Country:US
Practice Address - Phone:561-694-7776
Practice Address - Fax:561-694-3099
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant