Provider Demographics
NPI:1821371709
Name:PARISIAN, BROOKE ALEXANDRIA (AA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXANDRIA
Last Name:PARISIAN
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 TRAFALGAR CT STE 300W
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7425
Mailing Address - Country:US
Mailing Address - Phone:407-896-9500
Mailing Address - Fax:
Practice Address - Street 1:851 TRAFALGAR CT STE 300W
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7425
Practice Address - Country:US
Practice Address - Phone:407-896-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COANT.0000038367H00000X
FLAA106367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFM222ZMedicare PIN