Organization
DOH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMIE BROCKMAN (LPN)
(850) 342-0906
Entity
Organization
Contact information
Practice address
960 ROCKY BRANCH RD, MONTICELLO, FL 32344-2706
(850) 342-0906
Mailing address
960 ROCKY BRANCH RD, MONTICELLO, FL 32344-2706
(850) 342-0906
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5226936
FL
Other
Enumeration date
01/24/2017
Last updated
01/24/2017
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