Provider Demographics
NPI:1780268003
Name:FERNANDEZ, BROOKE (ND)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1211 CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-3372
Mailing Address - Country:US
Mailing Address - Phone:352-978-8507
Mailing Address - Fax:
Practice Address - Street 1:1211 CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3372
Practice Address - Country:US
Practice Address - Phone:352-978-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No132700000XDietary & Nutritional Service ProvidersDietary Manager
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12834006OtherCASH