Provider Demographics
NPI:1578194171
Name:STARR, BROOKE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:STARR
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 SUNDANCE PLACE LOOP
Mailing Address - Street 2:
Mailing Address - City:MULBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:33860-0179
Mailing Address - Country:US
Mailing Address - Phone:863-838-7671
Mailing Address - Fax:
Practice Address - Street 1:26606 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-8545
Practice Address - Country:US
Practice Address - Phone:813-907-0123
Practice Address - Fax:813-907-5559
Is Sole Proprietor?:No
Enumeration Date:2020-02-01
Last Update Date:2020-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005907363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care