Individual
SANDRA L BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
533 N NOVA RD STE 203, ORMOND BEACH, FL 32174-4422
(386) 672-7175
(386) 672-0771
Mailing address
533 N NOVA RD STE 203, ORMOND BEACH, FL 32174-4422
(386) 672-7175
(386) 672-0771
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2650922
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1790783207
MEDICARE PTAN Y4188Y
FL
05
—
305058100
—
FL
Enumeration date
07/08/2005
Last updated
12/22/2016
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