Provider Demographics
NPI:1689351272
Name:BRODIE, LORI M (PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:M
Last Name:BRODIE
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463185 STATE ROAD 200
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-5555
Mailing Address - Country:US
Mailing Address - Phone:904-225-8280
Mailing Address - Fax:
Practice Address - Street 1:463185 STATE ROAD 200
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-5555
Practice Address - Country:US
Practice Address - Phone:904-225-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11026560363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health