Provider Demographics
NPI:1104398478
Name:HARRIS, BROOKE ALLISON (APRN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALLISON
Last Name:HARRIS
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 1:338 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-3809
Mailing Address - Country:US
Mailing Address - Phone:701-306-0779
Mailing Address - Fax:
Practice Address - Street 1:1311 S MILLER ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6900
Practice Address - Country:US
Practice Address - Phone:805-922-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124955367500000X
CA95001355367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered