Provider Demographics
NPI:1417102146
Name:BROOKS, ASHLI A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ASHLI
Middle Name:A
Last Name:BROOKS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4602
Mailing Address - Country:US
Mailing Address - Phone:850-522-5490
Mailing Address - Fax:850-522-5491
Practice Address - Street 1:410 W 19TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4602
Practice Address - Country:US
Practice Address - Phone:850-522-5490
Practice Address - Fax:850-522-5491
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9233730363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily