Provider Demographics
NPI:1659541027
Name:LEEDY, BROOKE CAROLINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:CAROLINE
Last Name:LEEDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1211 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6735
Mailing Address - Country:US
Mailing Address - Phone:951-265-0672
Mailing Address - Fax:
Practice Address - Street 1:751 W LEGION RD
Practice Address - Street 2:
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-7732
Practice Address - Country:US
Practice Address - Phone:760-351-2627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-02
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant