Provider Demographics
NPI:1235887118
Name:JOHNSON, BROOKE LAMOUR
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LAMOUR
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 1:6080 SW 83RD PL
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-0030
Mailing Address - Country:US
Mailing Address - Phone:352-231-3282
Mailing Address - Fax:
Practice Address - Street 1:6080 SW 83RD PL
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-0030
Practice Address - Country:US
Practice Address - Phone:352-246-8566
Practice Address - Fax:734-322-0384
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9478475163W00000X
FLAPRN11030500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse