Provider Demographics
NPI:1942608138
Name:WESTBROOKS, AISHA
Entity Type:Individual
Prefix:MRS
First Name:AISHA
Middle Name:
Last Name:WESTBROOKS
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 1:8090 TIPPIN AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6357
Mailing Address - Country:US
Mailing Address - Phone:850-479-2706
Mailing Address - Fax:850-479-2705
Practice Address - Street 1:8090 TIPPIN AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6357
Practice Address - Country:US
Practice Address - Phone:850-479-2706
Practice Address - Fax:850-479-2705
Is Sole Proprietor?:No
Enumeration Date:2014-12-20
Last Update Date:2014-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12413172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker