Provider Demographics
NPI:1467096321
Name:BROOKER, STEPHANIE W
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:W
Last Name:BROOKER
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 1:3498 NW FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4441
Mailing Address - Country:US
Mailing Address - Phone:772-219-1080
Mailing Address - Fax:772-219-1083
Practice Address - Street 1:10771 SW TRADE ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987-2119
Practice Address - Country:US
Practice Address - Phone:772-219-1080
Practice Address - Fax:772-219-1083
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003165367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife