Provider Demographics
NPI:1457190852
Name:O'LAUGHLIN, BROOKE CLAIRE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:CLAIRE
Last Name:O'LAUGHLIN
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 1:10293 SOLTURA DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5998
Mailing Address - Country:US
Mailing Address - Phone:772-485-0070
Mailing Address - Fax:
Practice Address - Street 1:10293 SOLTURA DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5998
Practice Address - Country:US
Practice Address - Phone:772-485-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9529528163W00000X, 163WC0200X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program