Provider Demographics
NPI:1508369687
Name:HUFF, BROOKE RENAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:RENAE
Last Name:HUFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 TAYLOR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4536
Mailing Address - Country:US
Mailing Address - Phone:931-484-6061
Mailing Address - Fax:931-484-6062
Practice Address - Street 1:29 TAYLOR AVE STE 101
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4536
Practice Address - Country:US
Practice Address - Phone:931-484-6061
Practice Address - Fax:931-484-6062
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3567OtherSTATE OF TN