Provider Demographics
NPI:1346563129
Name:MCDUFFIE, BROOKE LEIGH (ACNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEIGH
Last Name:MCDUFFIE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 SPRING GLEN RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5978
Mailing Address - Country:US
Mailing Address - Phone:904-493-3390
Mailing Address - Fax:904-493-3395
Practice Address - Street 1:3115 SPRING GLEN RD
Practice Address - Street 2:SUITE 505
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5978
Practice Address - Country:US
Practice Address - Phone:904-493-3390
Practice Address - Fax:904-493-3395
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9191403363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care