Provider Demographics
NPI:1679168181
Name:ROBINSON, BROOKE ANN
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:ROBINSON
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 1:3D MED BN 3D MLG
Mailing Address - Street 2:UNIT 38449, A CO
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96373
Mailing Address - Country:US
Mailing Address - Phone:315-645-4473
Mailing Address - Fax:
Practice Address - Street 1:3D MED BN 3D MLG
Practice Address - Street 2:UNIT 38449, A CO
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96373
Practice Address - Country:US
Practice Address - Phone:315-645-4473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant