Provider Demographics
NPI:1831895655
Name:HOOVER, BROOKE LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LYNN
Last Name:HOOVER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:LYNN
Other - Last Name:MACKELBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:554 EDGECLIFF LN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-6426
Mailing Address - Country:US
Mailing Address - Phone:912-506-8449
Mailing Address - Fax:
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-722-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN277203207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology