Provider Demographics
NPI:1952641680
Name:BROCK, BROOKE KERN (APRN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:KERN
Last Name:BROCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:NICOLE
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5300 W HILLSBORO BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4397
Mailing Address - Country:US
Mailing Address - Phone:954-570-7644
Mailing Address - Fax:954-570-7884
Practice Address - Street 1:5300 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4395
Practice Address - Country:US
Practice Address - Phone:954-570-7644
Practice Address - Fax:954-570-7884
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9295455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily