Provider Demographics
NPI:1730457565
Name:BROOKS, TRESSIE (APRN)
Entity Type:Individual
Prefix:
First Name:TRESSIE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TRESSIE
Other - Middle Name:
Other - Last Name:SNIPES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 501
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5170
Mailing Address - Country:US
Mailing Address - Phone:386-615-0900
Mailing Address - Fax:386-615-0902
Practice Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 501
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5170
Practice Address - Country:US
Practice Address - Phone:386-615-0900
Practice Address - Fax:386-615-0902
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202650363LA2100X
FLAPRN9243329363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108219600Medicaid