Provider Demographics
NPI:1558817841
Name:BROOKS, ROBIN
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:BROOKS
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 1:6229 W SUNRISE BLVD
Mailing Address - Street 2:SUITE 211C
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33313-0000
Mailing Address - Country:US
Mailing Address - Phone:954-643-6443
Mailing Address - Fax:954-578-2165
Practice Address - Street 1:6299 W SUNRISE BLVD
Practice Address - Street 2:SUITE 211C
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-6180
Practice Address - Country:US
Practice Address - Phone:954-643-6443
Practice Address - Fax:954-578-2165
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL210676163W00000X
FL234401163WA0400X, 164W00000X, 372600000X, 374U00000X
FL23390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No372600000XNursing Service Related ProvidersAdult Companion
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program