Individual
BROOKE REVELL SANSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
19611 FL-20 WEST, BLOUNTSTOWN, FL 32424
(850) 674-5645
Mailing address
19611 FL-20 WEST, BLOUNTSTOWN, FL 32424
(850) 674-5645
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9435556
FL
363LF0000X
Family Nurse Practitioner
Primary
11015583
FL
Other
Enumeration date
10/11/2019
Last updated
11/12/2021
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