Provider Demographics
NPI:1457892226
Name:BROOKS, JEANNETTA ANN (APN)
Entity Type:Individual
Prefix:MS
First Name:JEANNETTA
Middle Name:ANN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:3641 CLYDE MORRIS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-2357
Practice Address - Country:US
Practice Address - Phone:386-675-4410
Practice Address - Fax:866-542-5859
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN260247363LF0000X
NJ26NJ00774600363LF0000X
FLAPRN11005670363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily