Provider Demographics
NPI:1568740918
Name:TOBIA, BROOKE L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:L
Last Name:TOBIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:BROOKE
Other - Middle Name:L
Other - Last Name:ANCHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2405 E 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5961
Mailing Address - Country:US
Mailing Address - Phone:586-264-1800
Mailing Address - Fax:586-264-1155
Practice Address - Street 1:2405 E 14 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5961
Practice Address - Country:US
Practice Address - Phone:586-264-1800
Practice Address - Fax:586-264-1155
Is Sole Proprietor?:No
Enumeration Date:2011-08-02
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006081363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical