Provider Demographics
NPI:1861597031
Name:BROOKS, JEANNE FLORENCE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:FLORENCE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9613 201ST STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-6495
Mailing Address - Country:US
Mailing Address - Phone:253-375-7752
Mailing Address - Fax:253-967-8224
Practice Address - Street 1:MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:9400 JACKSON AVE
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-967-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60027834363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPA60027834OtherSTATE LICENSE