Provider Demographics
NPI:1952327611
Name:BROOKS, MARY C (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:BROOKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:GRAHAM-ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:6101 LAKE ELLENOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-4616
Mailing Address - Country:US
Mailing Address - Phone:407-858-1400
Mailing Address - Fax:407-858-5523
Practice Address - Street 1:12050 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4705
Practice Address - Country:US
Practice Address - Phone:407-838-1495
Practice Address - Fax:407-249-4456
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9240995363LF0000X
FLARNP 9240995363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL307516800Medicaid
FL307516800Medicaid
AJ332ZMedicare PIN