Provider Demographics
NPI:1306716204
Name:BROOKS, ASHA
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:BROOKS
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 1:14050 INTEGRA DR APT 917
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2665
Mailing Address - Country:US
Mailing Address - Phone:904-701-4485
Mailing Address - Fax:
Practice Address - Street 1:14050 INTEGRA DR APT 917
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2665
Practice Address - Country:US
Practice Address - Phone:904-701-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL567687146N00000X
FL241105372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic