Provider Demographics
NPI:1538161419
Name:GREGORY, BROOKE ANNE (ARNP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W GORE ST
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1124
Mailing Address - Country:US
Mailing Address - Phone:407-581-2888
Mailing Address - Fax:407-481-0073
Practice Address - Street 1:1000 W BROADWAY ST
Practice Address - Street 2:SUITE 206A
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9260
Practice Address - Country:US
Practice Address - Phone:407-581-2888
Practice Address - Fax:407-992-7701
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3179522363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner