Provider Demographics
NPI:1235398025
Name:BROOKS, JUDITH C (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:C
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 SE HILLMOOR DR STE B9
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7540
Mailing Address - Country:US
Mailing Address - Phone:772-348-0303
Mailing Address - Fax:772-348-0307
Practice Address - Street 1:1701 SE HILLMOOR DR STE B9
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7540
Practice Address - Country:US
Practice Address - Phone:772-348-0303
Practice Address - Fax:772-348-0307
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1190915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine