Organization
BROCK AND HARRISON SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACKIE LEE BROCK (PRESIDENT)
(727) 612-8031
Entity
Organization
Contact information
Practice address
3344 23RD ST N, ST PETERSBURG, FL 33713-2708
(727) 612-8031
(727) 914-8107
Mailing address
3344 23RD ST N, ST PETERSBURG, FL 33713-2708
(727) 612-8031
(727) 914-8107
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 5212877
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851791917
NPI
FL
Enumeration date
12/12/2014
Last updated
12/12/2014
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