Provider Demographics
NPI:1215567565
Name:BROOKE, JOSEPHINE ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:ELIZABETH
Last Name:BROOKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:ELIZABETH
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4207
Practice Address - Street 1:520 A1A N STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-2260
Practice Address - Country:US
Practice Address - Phone:904-273-6900
Practice Address - Fax:904-390-7479
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005572363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily