Provider Demographics
NPI:1780403535
Name:ORUM, BROOK (LPN)
Entity type:Individual
Prefix:
First Name:BROOK
Middle Name:
Last Name:ORUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BROOK
Other - Middle Name:
Other - Last Name:ORUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:35363 SARAH LYNN DR APT 205
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-8345
Mailing Address - Country:US
Mailing Address - Phone:727-741-8245
Mailing Address - Fax:
Practice Address - Street 1:35363 SARAH LYNN DR APT 205
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-8345
Practice Address - Country:US
Practice Address - Phone:727-741-8245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5203440164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7574015953Medicaid
FL5203440OtherFLORIDA BOARD OF NURSING