Provider Demographics
NPI:1568053544
Name:MOTYL, BROOKE (CRNP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MOTYL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 EVANSBURG RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-1020
Mailing Address - Country:US
Mailing Address - Phone:843-714-7123
Mailing Address - Fax:
Practice Address - Street 1:1887 KINGSLEY AVE STE 1500
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4481
Practice Address - Country:US
Practice Address - Phone:904-633-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022293363LW0102X
FL11013698363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health