Provider Demographics
NPI:1740503408
Name:BROOKS, CATHERINE R (LPN)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:R
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:R
Other - Last Name:CARTIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:330 KAY LARKIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177
Mailing Address - Country:US
Mailing Address - Phone:386-329-3780
Mailing Address - Fax:386-385-1269
Practice Address - Street 1:330 KAY LARKIN DRIVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177
Practice Address - Country:US
Practice Address - Phone:386-329-3780
Practice Address - Fax:386-385-1269
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5146806164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse