Provider Demographics
NPI:1881290948
Name:HATFIELD, BROOKE DANIELLE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:DANIELLE
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 PICKWICK DR
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:IL
Mailing Address - Zip Code:61068-1092
Mailing Address - Country:US
Mailing Address - Phone:815-761-5212
Mailing Address - Fax:
Practice Address - Street 1:1639 N ALPINE RD STE 360
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1440
Practice Address - Country:US
Practice Address - Phone:815-229-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.008003363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant