Individual
BROOKE INA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3043 INTERNATIONAL GOLF PKWY, ST AUGUSTINE, FL 32092-0032
(904) 201-4304
Mailing address
3911 COASTAL COVE CIR, JACKSONVILLE, FL 32224-0004
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
29004
FL
Other
Enumeration date
06/05/2024
Last updated
06/05/2024
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