Provider Demographics
NPI:1497488407
Name:BROOKS, PATRICK RYAN (RN)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:RYAN
Last Name:BROOKS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 OLD COURTHOUSE WAY UNIT B
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-8064
Mailing Address - Country:US
Mailing Address - Phone:727-422-3483
Mailing Address - Fax:
Practice Address - Street 1:5 OLD COURTHOUSE WAY UNIT B
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-8064
Practice Address - Country:US
Practice Address - Phone:727-422-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9510527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse